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Exercising with Asthma

Do you cough, wheeze, and have a tight chest or shortness of breath when you exercise?

If yes, you may have exercise-induced bronchoconstriction (EIB). This happens when the tubes that bring air into and out of your lungs narrow with exercise, causing symptoms of asthma.

An estimated 300 million people worldwide have asthma, according to the World Health Organization, and strenuous exercise can make it worse. Some people with EIB do not otherwise have asthma, and people with allergies may also have trouble breathing dur-ing exercise.

Symptoms
If you have EIB, you may have problems breathing within
5 to 20 minutes after exercise. Your symptoms may include wheezing, tight chest, cough, shortness of breath, and, rarely, chest pain.

Triggers
People with EIB are
typically very sensitive to both low temperatures and dry air. Air is usually warmed and humidified by the nose, but during demanding activity, people breathe more through their mouths. This allows cold, dry air to reach your lower airways and your lungs without passing through your nose, triggering asthma symptoms. Air pollutants, high pollen levels, and viral respiratory
infections may also be triggers. Other causes of symptoms while exercising include being out of shape, poorly
controlled nasal allergies, and vocal
cord issues.

Hiking, walking, and leisure biking are good sporting activities for people with EIB.

Diagnosis
Wheezing or tightness
in your chest can be serious, so let your physician know about your symptoms. Your physician can help you by getting your health history, performing a breath­ing test called spirometry at rest, and doing a follow-up exercise challenge test. If your breathing test shows that you might have asthma, your physician may give you a medication, such as albuterol, to inhale. If your breathing test numbers improve after inhaling the medicine, then the diagnosis of asthma is more likely.

You may be asked to take an addi­tional test, called a bronchoprovocation challenge test. Your physician will
have you exercise in the sport you
play, run outside, or cycle or run
on a treadmill. Before and after the
exercise, your physician will test the amount of air you force out of your lungs with a spirometry test. If you
exhale air less forcefully after exercise, the problem may be EIB.

Treatment
If you have been diag­nosed with EIB, talk with your doctor before you begin an exercise program. Together, you can develop a treatment plan that will allow you to participate in activities with minimal asthma symptoms.

EIB associated with more generalized asthma is prevented with controller medications taken regularly (such as mast cell stabilizers, inhaled steroids, and leukotriene modifiers) or by using medicines before you exercise (short-acting beta-agonists, such as albuterol). When EIB symptoms occur, they can be treated with short-acting beta-agonists. In addition to taking medications, warm­ing up and cooling down as part of your exercise routine may prevent or lessen EIB. You may want to limit ex­ercise when you have a viral infection, air temperatures are low, or pollen and
air pollution levels are high.

Exercising with EIB
People with EIB are still able to exercise – and should exercise regularly. But you need to be sure that you are doing the right kind and right amount of exercise.

The sport you choose can affect
your symptoms. Swimming is considered less likely to cause asthma symptoms because the warm, humid environment of the pool does not
aggravate the airways. Hiking, walk­ing, and leisure biking are also good sporting activities for people with
EIB. Team sports that require short bursts of energy, such as baseball,
football, and short-term track and
field, are less likely to cause symptoms than are sports that have a lot
of ongoing activity, such as soccer,
basketball, field hockey, or long-distance running. Cold weather
activities like cross-country skiing
and ice hockey are more likely to
make symptoms worse, but with
proper diagnosis and treatment, many people with EIB can participate and excel in almost any sport or activity.

Exercise is important and provides many health benefits, especially for people with asthma. So don’t give
up on having an active lifestyle.

The 411 on Food Allergies

An allergic reaction to a food is an unpleasant reaction caused by the immune system overreacting to a food. The most common type of food allergy is caused by an overly sensitive immune system that creates IgE antibodies directed against an otherwise harmless protein in the food.

Unpleasant reactions to foods not caused by the immune system are con­sidered to be food intolerances. Food intolerances have various causes. For example, a person may lack an enzyme needed to digest a portion of a certain food, as is the case with lactose intoler­ance. Or the food may be contaminated by bacterial or other toxins that cause symptoms resembling those of food allergy, which is what happens when someone has food poisoning.

Since so many people have a nega­tive reaction to a food at some time in their lives, the public perception of the prevalence of food allergy is skewed. In reality, very few people are truly allergic to foods. It is estimated that eight percent of young children, and three to four percent of adults, have food allergies. However, for those who are allergic, it is important to diagnose the allergy and identify the food so that serious, and even life-threatening, reac­tions can be avoided.

There is currently no cure for food allergy, but treatments are being investi­gated. While injectable epinephrine and antihistamines can be used to alleviate symptoms resulting from accidental exposures, the best way to manage food allergies is through complete avoidance of the suspected food.

The following are some tips to help prevent food allergic reactions: ♦ Know the different names of foods to which you are allergic. (For example, lactate solids are a milk product.)♦ Read labels carefully to identify the ingredients in packaged food.♦ Ask about ingredients in food served at a restaurant or a friend’s home.♦ Educate caregivers about food
allergies.♦ Encourage children with food allergies not to eat food given to them by friends.♦ Have a food allergy action plan.♦ Always carry injectable epineph­rine (like an EpiPen or AuviQ) and
an oral antihistamine as prescribed
for emergencies.

You can learn more about your food allergies and how to avoid foods you are allergic to by talking with your doctor or a registered dietitian.

Food Allergy FAQ

Q: What are common symptoms of
food allergies?
A: Symptoms can vary, but common food allergy symptoms are abdominal pain, vomiting, diarrhea, trouble swallow­ing, swelling (of the face, hands, etc.), hives, and itching. Some children and adults also experience coughing and wheezing. In very severe cases, trouble breathing, fainting, and shock can occur.
Q: What foods are most likely to cause food allergy?
A: The most common foods to cause allergic reactions in young children are milk, eggs, wheat, soy, and peanuts. For adults, the most common foods to cause allergic reactions are fish, shellfish, pea­nuts, and tree nuts.
Q: What is the difference between food allergy and food intolerance?
A: Having an unpleasant reaction to food is a fairly common problem. Fortunately, true food allergy is a relatively uncommon medical condition. An allergic reaction to a food is caused by the immune system overreacting to a specific component of that food. A food intolerance can cause similar unpleasant reactions when eating a food, but the immune system is not involved. The most common example of a food intolerance is lactose intolerance.
Q: Are there links between food
intolerances and skin reactions such
as psoriasis?
A: There are no links known at
the present.
Q: Are those who have MSG allergies more apt to have problems with seasonal allergies?
A: There is no relationship between seasonal allergy and MSG intolerance.
Q: Can an antihistamine prevent allergic reactions in people with food allergies?
A: For those with a true food allergy, taking an antihistamine during an allergic reaction may be helpful to relieve the hives and itching. However, antihistamines have little role in relieving any type of respiratory problem. If a person is having anaphylaxis or respiratory symptoms (such as throat closing, coughing, or wheezing), the only treatment that is effective is injectable epinephrine. For adverse reactions to foods that are not allergic in nature, antihistamines have little effectiveness.
Q: Can someone outgrow peanut allergy?
A: Young children often outgrow their food allergies, especially to soy, wheat, egg, and milk products. It is less likely that a child will outgrow peanut allergy. How­ever, studies during the past few years have indicated that about 20 percent of children with allergic reactions to peanut in the first years of life may eventually outgrow their sensitivity. Children with food allergies should see their allergist at least annually to reevaluate their allergies.

Asthma Triggers and How to Avoid Them

An asthma trigger is anything that makes your asthma worse. When you encoun­ter one of your triggers, it can cause a sudden worsening of asthma symptoms, which is often called an asthma attack, episode, or flare-up.

Knowing what causes your asthma symptoms is an important step to con­trolling your asthma. Common asthma triggers include respiratory infections, allergens, irritants, exercise, and strong emotions. Your doctor can help you identify what makes your asthma worse. Once you know what causes your symp­toms, you can work with your doctor to come up with a plan for managing your asthma and avoiding your triggers.

Here’s a breakdown of the most com­mon asthma triggers, along with some tips for reducing your exposure to them.

Medical Conditions
Respiratory infections, such as a cold, flu, or sinus infection, are the most common cause of asthma symptoms leading to an
asthma flare-up. Washing your hands frequently and avoiding people who
are sick will help to reduce your exposure to cold and flu. However, the best way to prevent the flu is to get
a flu vaccine every year. Pregnancy hormones and other medical condi­tions, such as acid reflux, can also worsen asthma symptoms.

Food & Medicines
Asthma can be triggered by food allergies and certain medications. Discuss with your doctor any over-the-counter or prescription medicines you take, such as aspirin, fever-reducers, or anti-inflammatories, as well as any alternative therapies or herbal remedies you use, as they may have an impact on your asthma.

Smoke
All types of smoke can make it hard to breathe, including smoke from wood-burning fireplaces, campfires, burning leaves, cigarettes, cigars, and pipes. If you smoke, you should make a plan to quit. If you don’t smoke but live with someone who does, ask that he or she smoke outside, and discuss other ways to prevent or limit your
exposure to tobacco smoke.

Knowing what causes your asthma symptoms is an important step to controlling your asthma.

Weather, Pollen, & Air Pollution
Changes in the season can bring on an asthma episode due to increased pollen in the air. Limit your time outdoors when pollen counts are high, especially during spring and fall. Extreme temperatures; cold, windy, or stormy weather; high humidity; and air pollution, including smog, vehicle exhaust, and other fumes, can also cause problems for asthma fighters. Be prepared for the weather and outdoor air conditions before you leave your home by checking the pollen counts and air quality index for your area.

Animals
Dander and saliva from animals with fur or feathers – including cats, dogs, ferrets, hamsters, Guinea pigs, bunnies, mice, and birds – are common allergy triggers, and for some people, they can cause asthma symptoms. Re­duce your exposure to pet allergens by vacuuming and damp dusting weekly. Try to keep your pets out of your bed­room and any other rooms where you spend a lot of time.

Pests
Dust mites, cockroaches, and rodents aren’t just annoying; these little guys, which can be found in your home, workplace, and school, can trigger asthma symptoms. To reduce your exposure to these triggers, wash bedding regularly, fix leaks, store garbage outside, vacuum and dust weekly, and use allergen-proof pillow and mattress covers.

Mold
Mold is another common
allergen that can trigger asthma symp­toms. You can reduce your exposure to mold by cleaning any visible mold in your home with mild soap, hot water, and a strong brush. Throw away moldy items that cannot be cleaned. To help prevent future mold growth, run a
dehumidifier, fix leaking pipes and
faucets, and turn on the exhaust fan when you take a shower.

Exercise
Staying active is very
important to your overall health and well-being, especially for people with asthma. If you know that exercising
or playing sports triggers your asthma symptoms, use your quick-relief medi­cine 15 to 30 minutes before engaging in physical activity, if prescribed. Re­member to monitor the local air quality if you plan to exercise or play outside.

Emotions
Emotional ups and downs are part of life. But before you lose your composure, remember that strong emo­tions can increase rapid breathing and trigger asthma symptoms. Stress, both personal and work related, can be a major trigger as well. The same goes for laugh­ing or crying too hard, yelling, and feeling anxious, angry, or afraid.

Strong Odors
Scents from perfumes, deodorants, and cleaning supplies can leave you gasping for air. Scents from gas stoves, scented candles, incense, hairspray, and air fresheners can also cause asthma symptoms. When pos­sible, choose cleaning and personal care products that are both odor- and fragrance-free.

For more information on lung health, visit
Lung.org/asthma or call the American Lung
Association’s Lung HelpLine at (800) 586-4872
to speak with a lung health expert.

Going on Vacation?

Send Your Allergy & Asthma Symptoms Packing

Thinking of traveling by plane or train? Taking a road trip? Follow these tips to help prevent asthma and allergy flare-ups during your special adventure.

Plan Before Your Trip
As you’re finalizing plans for
your next vacation, it’s important to also prepare for your medical needs. Refill your prescription medications and pick up over-the-counter medicines before packing for your trip. Create a list of your current medical conditions, medications, prescribing physician, and dosage to have on hand while traveling. If you have asthma or severe allergies, consider ordering and wearing a medical identification bracelet.

Check with your allergist or doctor to discuss any travel-related risks and to update your asthma action plan or allergy action plan. Be sure to get your immunizations, especially
a flu shot. You should also check your health insurance
policy and know in advance if your plan will cover doctor
or emergency visits in other states or countries.

If you have food allergies, be sure to have an allergy
alert chef’s card to help you alert restaurant staff about your allergies while traveling. It’s also a good idea to check the weather and pollen forecast for your destination.

♦
When traveling by air … If you have a pet or food allergy, call the airlines and explain your medical condition to their customer service representative. Find out the airline’s poli­cies on accommodations for people with allergies.

Pack your medications with their original labels on. If possible,
bring back-up medicines.

If you have food allergies, be sure to have an allergy
alert chef’s card to help you alert restaurant staff about your allergies while traveling. It’s also a good idea to check the weather and pollen forecast for your destination.

♦
When traveling by air … If you have a pet or food allergy, call the airlines and explain your medical condition to their customer service representative. Find out the airline’s poli­cies on accommodations for people with allergies.

For pet allergies, find out if the airline allows pets to travel in the passenger cabin. Ask if another passenger on the same flight has made reservations with a pet and if you can be seated away from the animal. Take note that federal law must allow service animals in passenger cabins. Additionally, all flights will have pet dander, even without pets in the plane, because pet dander gets on people’s clothes.

If you have nut allergies, or any other food allergy, find out if the airline has a policy for accommodating people with food allergies. Ask if you can pre-board to wipe down your seat and tray table, and see if the airline can create an allergen-free buffer zone around your row. You should also find out if you can order a safe meal for your food allergy.

♦
When traveling by car … If you have a pollen or mold allergy, you’ll want to service your vehicle to replace air filters and clean the ventilating and air conditioning system before you leave.

♦
When traveling by train … If you have a pet or food
allergy, find out if the train allows pets (in addition to
service animals), and ask to be seated away from animals.
If meals are served on board, ask if the dining staff can
accommodate your food allergies. If not, make sure you
can bring your own food.

♦
When staying in a hotel … Request a hotel room that is nonsmoking, mold-free, and pet-free. Ask the hotel staff if
they provide allergy-friendly rooms.

Packing for Your Trip
Pack your medications with their original labels on. If possible, bring back-up medicines. You should also pack your health insurance card and list of medi­cal conditions and medications. Always keep your medications with you – so pack them into a carry-on bag or backpack
that stays with you at all times. Medically necessary liquids and medications in excess of TSA limits are allowed in your carry-on bag, but they still must be screened.

If you or someone in your family has a food or insect sting allergy, be sure to bring your self-injectable epinephrine. These are also allowed on airplanes. If you have a food allergy, pack safe foods to eat, and don’t forget to bring your allergy alert chef’s card. If you will be flying to your destination, inform the TSA agent at the beginning of the screening process about your allergies and necessary supplies.

Unexpected detours during travel can be fun, but not when they
are health related.

Pack your asthma equipment: spacers, nebulizers, and peak flow meters. If you use a nebulizer, it should not be left at home. For campers and others who vacation “in the rough,” consider portable nebulizers. Some are battery powered; others can be plugged directly (or through a power inverter) into the 12-volt receptacles in your vehicle. If traveling abroad, be sure you have an electrical current converter. When flying, tell the TSA agent about your nebulizer or other equipment so they can screen it.

No matter how you’re traveling, pack wipes to clean
surfaces such as airplane tray tables and public seating areas. To protect against dust mites, pack your own allergy-proof pillow or mattress casings.

During Your Trip
Always carry your emergency medica­tions with you everywhere you go, and know the nearest locations to seek medical treatment. Reduce your risk of respiratory infections by frequent hand washing and using hand sanitizers. During hot weather, people with asthma
and allergies should stay hydrated and drink plenty of fluids. And everyone should avoid exposure to tobacco smoke.

If you are traveling by car during high pollen or pollution times, travel with your windows up and the air conditioning turned on. If you’re the one who is driving, be aware that some allergy medications may cause drowsiness.

When traveling by plane, ask if you can pre-board, and be sure to tell the flight attendants about your medical con­dition. Wipe down your armrests and tray tables as soon as you board, and avoid using airline pillows or blankets. If you have a food allergy, consider only eating food that you packed with you.

Unexpected detours during travel can be fun, but not when they are health related. By taking these precautions before and during your trip, you can enjoy your next get­away – without the allergy and asthma symptoms.

Don’t Let Allergies & Asthma Spoil Your Outdoor Fun

Outdoor spring and summer activi­ties can bring plenty of unwanted guests – from mosquitos and rain to your nosey next-door neighbor. The last thing you want to worry about is allergy and asthma triggers putting a damper on your warm weather plans. Before you resign yourself to spending these beautiful, sunny days indoors, try these tips to help you identify the allergy and asthma triggers that may be lurking in your backyard and prevent them from spoiling your outdoor fun.

Steer clear of stings.
Backyard bugs can be more than just a nuisance. For people who are allergic to insect stings, they can cause a life-threatening allergic reaction known as anaphylaxis. If you have a known insect allergy, always carry your prescribed epinephrine. You can avoid stings by always wearing shoes in the yard, keeping food covered, and not drinking from open soft drink containers, which attract bugs. Skip sweet-smelling perfumes, deodorants, and hairspray, and avoid wearing brightly colored clothing.

Manage mold.
Grass, tree, and weed pollens aren’t the only environ­mental allergy and asthma triggers. Outdoor molds can grow on rotting logs, in compost piles, and on grasses and grains. Warm weather promotes mold growth, which can lead to sneezing, a runny or stuffy nose, itchy throat and eyes, hives, and wheezing. If your symp­toms are severe, your allergist may prescribe treatment that goes beyond over-the-counter medications, such as immunotherapy to help your body build a natural immunity to the trigger.

Warm weather promotes mold growth, which can lead to sneezing, a runny or stuffy nose, itchy throat and eyes, hives, and wheezing.

Screen your sunscreen.
While it is possible to be allergic to the sun and break out in hives after exposure, you might also be allergic to your sunscreen. If you notice a rash or itchy skin after applying sunscreen, the chemicals in the lotion might be causing contact
dermatitis. Opt for natural sunscreens or those that don’t use the chemicals benzophenone, octocrylene, and PABA (para-aminobenzoic acid), which can commonly cause contact dermatitis.

Bring your own barbecue.
If you have food allergies, attend backyard barbecues with caution. Not only can food allergens be hidden in salads and sauces, cross-contamination can also occur, commonly when the same uten­sils are used for grilling and serving side dishes and when condiment bottles are shared. Bring an allergen-free dish for yourself, and use condiment packets. Always carry two doses of prescribed epinephrine as well.

Stifle the smoke.
Smoke from
the grill, fireworks, or bonfire can be extremely bothersome if you have
asthma; it can even trigger an asthma attack. Sit upwind of the smoke, and avoid getting too close. Always carry your reliever inhaler.

Be careful of chlorine.
Warmer weather means getting in the water, but some people fear a chlorine allergy. While chlorine isn’t actually an aller­gen, it can be irritating, causing eye and nose itching. And it can cause some with asthma to experience difficulty breath­ing. Usually, washing the affected area with clean water removes the irritant, although sometimes, a corticosteroid cream may need to be prescribed.

Take notice of the temperature.
You’ve been looking forward to enjoy­ing the warm weather, but be careful of sudden temperature changes, which can trigger an asthma attack. Going inside a cold air-conditioned building or jump­ing into cold water could be a trigger.

Watch out when you work out.
Con­sider indoor exercise and other activities on hot, humid, and high-pollen days, and watch out for “ozone alert” days. Exer­cise outdoors when pollen counts are
at their lowest – pre-dawn or in the late afternoon or evening. Take a shower, wash your hair, and change your cloth­ing after exercise, as pollen can stick to your hair, clothing, and shoes, causing you to bring pollen indoors.

Mind your mouth.
Spring and
summer means the bounty of farmers markets. If you suffer from hay fever and have had an itchy mouth or scratchy throat after eating certain raw fruits or vegetables, you may have oral allergy syndrome. Oral allergy syndrome is caused by cross-reacting allergens found in both pollen and some raw fruits and vegetables. Symptoms of oral allergy syndrome include itchy mouth, scratchy throat, and swelling of the lips, mouth, or tongue. Because the symptoms often subside quickly once the fresh fruit or raw vegetable is swallowed or removed from the mouth, treatment is not usually necessary. Once fruit is cooked, the symptoms typically go away as well.

Going to Work without Laboring for Breath

How to Handle Asthma Hazards in the Workplace

The vast majority of the American workforce spends at least part of their day laboring indoors, where serious health dangers may be lurking in the air they breathe. According to
the Occupational Health & Safety
Administration, approximately 11 mil­lion workers, including those who are employed by offices, restaurants, and industrial facilities, are exposed to at last one or more substances in their workplace that could cause asthma symptoms.

Many of these workers have legiti­mate concerns about their workplace environment, as demonstrated by these common questions from callers to the American Lung Association’s Lung HelpLine: &diam; “I cannot access the employee entrance at my work due to other employees and visitors smoking. What can I do?”&diam; “I work in a small office, and a few coworkers wear so much perfume it chokes me and I have to use my rescue inhaler several times. How do I get them to realize they are making me sick?”&diam; “I use a company vehicle that is shared with other employees, including some who smoke in the vehicle. This makes my asthma worse. How can I avoid this?”&diam; “The building I work in had water damage, and now has a smell that makes me and a few other coworkers sick. We think it might be mold. What can we do?”

Having solid policies in
place to protect your lung health can mean less time spent struggling for breath and more time focusing on your job.

If you suspect your workplace has unhealthy air,
follow these 3 important steps:

1 Let your supervisor and building man­agement know there may be a problem. Follow the usual and proper steps to alert them, as you may need to document the steps you took later.
2 Tell your healthcare provider about your symptoms. Report
the symptoms to your company’s health or safety officer. The state or local health depart­ment may also need to be informed. Ask the health or safety
officer if you should do that yourself.
3 Work with management as they
investigate the prob­lem. The process
may take longer than anyone wants be­cause the underlying problems may be
difficult to identify.

Your work environment shouldn’t cause your asthma to worsen. Whether you work in an office, store, restau­rant, or factory, having solid policies
in place to protect your lung health
can mean less time spent struggling
for breath and more time focusing on your job.

Even people who aren’t coping with asthma can have allergic sensitivities
to perfumes and strong fragrances found in some cleaning products and air fresheners. And no one’s lungs
are safe when having to inhale second­hand smoke.

Become a Polite Advocate Your employer has a vested interest in your health and safety while on the clock. If your place of business doesn’t already have a smokefree or scent-free policy in place, talk with your immediate
supervisor about your health concerns.

The American Lung Association has created a Guide for Controlling Asthma at Work (available at lung.org) to help adults living with asthma recognize if their workplace is making them sick.
It also outlines steps you can follow
to take control. Taking time to educate
yourself about asthma and the com­ponents of a lung-friendly workplace will help you have a productive con­versation with your supervisor as you advocate for better workplace health.

Signs of Potential Problems

Depending on the industry, workers may be at risk from exposure to tobacco smoke, carbon monoxide, allergens, bacteria, viruses, and chemi­cals that build up indoors. Workers may also be exposed to airborne contaminants on the job, such as dusts, weld­ing fumes, gases, and solvent vapors and mists.

In those situations, take
immediate steps to get peo­ple out of danger and limit harm. Notify and seek help from the appropriate emer­gency agency, such as the fire department, gas supplier, health department, or hazard­ous waste authority. Evacuate the area if necessary. And
get medical help for people with symptoms.

One in twelve adults has asthma, and you’re
not alone in your concerns. The American Lung Association’s Lung HelpLine can help provide advice on how to make your workday healthier and safer. Call 1-800-LUNG-USA (586-4872) for immediate help from a trained staff of respiratory therapists, counselors,
and registered nurses. You can also submit
a question online at lung.org.

This article was originally published in Coping® with Allergies & Asthma magazine,
Fall/Winter
2015-2016.

A Closer Look at Eye Allergies

If your eyes itch and are red, tearing, or burning, you may have eye allergies (also called allergic conjunctivitis), a condition that affects millions of Americans. Let’s take a closer look at this troublesome allergic condition and what you can
do to get relief.

Know the Symptoms Seasonal allergic conjunctivitis is by far the most common type of eye allergy.
It is caused by reactions to pollens from grass, trees, or weeds. People with sea­sonal allergic conjunctivitis experience symptoms in spring, summer, or fall, depending on the type of plant pollens in the air. Typical symptoms include

Itching

Redness

Burning

Clear, watery discharge

People with seasonal allergic con­junctivitis may have chronic dark circles (known as allergic shiners) under their eyes. Their eyelids may be puffy, and bright lights may be bothersome. Sea­sonal allergic conjunctivitis symptoms often accompany the runny nose, sneez­ing, and nasal congestion associated with hay fever and other seasonal allergies. The itching may be so bothersome that it causes you to rub your eyes frequently – making symptoms worse and poten­tially causing infection.
Perennial allergic conjunctivitis,
as its name implies, occurs year-round. Symptoms are the same as with seasonal allergic conjunctivitis, but tend to be milder. They are caused by reactions to dust mites, mold, pet dander, or other household allergens, rather than pollen.

The symptoms of eye allergy can range from mildly annoying redness to inflammation severe enough to impair vision.

Get a Diagnosis
Eye allergies share symptoms with some diseases of the eye, making
accurate diagnosis imperative. The symptoms of eye allergy can range from mildly annoying redness to inflamma­tion severe enough to impair vision. If symptoms persist, see an allergist, who will review your medical history and symptoms and then conduct tests to con­firm whether your symptoms are indeed caused by eye allergies.

Avoid Your Triggers
The first approach in managing eye
allergy should be to avoid the allergens that trigger your symptoms.

Outdoor exposure
Stay indoors as much as possible when pollen counts are at their peak, usually during the midmorning and early evening, and when wind is blowing pollens around. Avoid using window fans that can
draw pollens and molds into the house. Wear glasses or sunglasses when out­doors to minimize the amount of pollen getting into your eyes. And try not to rub your eyes, which will irritate them and could make your condition worse.

Indoor exposure
Keep windows closed, and use air conditioning in your car and home. Air conditioning units should be kept clean. Take steps to
reduce your exposure to dust mites, especially in the bedroom. Use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs. Wash your bedding frequently, using hot water (at least 130 degrees Fahrenheit). To limit exposure to
mold, keep the humidity in your home low (between 30 and 50 percent), and clean your bathrooms, kitchen, and basement regularly. Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with detergent and a five percent bleach solution. Clean floors with
a damp rag or mop, rather than dry dusting or sweeping.

Exposure to pets
Wash your hands immediately after petting any animals, and wash your clothes after visiting friends with pets. If you are allergic
to a household pet, keep it out of your home as much as possible. If the pet must be inside, keep it out of the bed­room so you are not exposed to animal allergens while you sleep. Close the
air ducts to your bedroom if you have forced-air or central heating or cooling. And replace carpeting with hardwood, tile, or linoleum, all of which are easier to keep dander-free.

Take Medication If Needed
Many allergens that trigger eye aller­gies are airborne, so you can’t always avoid them. Talk with your allergist to see if over-the-counter or prescription medication is needed to help you con­trol your eye allergy symptoms.

Live Well with COPD

Chronic obstructive pulmonary disease, or COPD, is a progres­sive disease that makes it hard to breathe. “Progressive” means the disease gets worse over time. COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness, and other symptoms.

COPD develops slowly and is diag­nosed most commonly in middle-aged or older adults. Symptoms often worsen over time and can limit your ability
to do routine activities. Severe COPD may prevent you from doing even basic
activities like walking, cooking, or tak­ing care of yourself.

COPD has no cure yet, and doctors don’t know how to reverse the damage to the airways and lungs. However,
adhering to treatments and making some lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.

Avoid lung irritants.
If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about pro­grams and products that can help you quit. If you have trouble quitting smok­ing on your own, consider joining a support group or a smoking cessation class. Ask your family members and friends to support you in your efforts
to quit as well.

Lung irritants, such as secondhand smoke, air pollution, chemical fumes, and dust, also can contribute to COPD. Keep these irritants out of your home. If you have your home painted or sprayed for insects, have it done when you can stay away for a while. Keep your windows closed and stay at home (if possible) when there’s a lot of air pollution or dust outside.

Adhering to treatments and making some lifestyle changes can help you feel better, stay more active, and slow the progress
of the disease.

Get ongoing care.
If you have COPD, it’s important to get ongoing medical care. Take all of your medicines as your doctor prescribes, and make sure to refill your prescriptions before they run out. Bring a list of all the medicines you’re taking to your medical checkups.

Talk with your doctor about when
or if you should get flu and pneumonia vaccines. Ask about other diseases for which COPD may increase your risk, such as heart disease, lung cancer,
and pneumonia.

Manage COPD and its symptoms.
In addition to receiving ongoing care, you can make some lifestyle changes to help manage COPD and its symptoms. If your symptoms are mild, you may make small adjustments to your routines to make breathing easier, like taking the elevator instead of the stairs when the option is available.

If physical exertion causes you to become short of breath, do activities slowly. Wear shoes and loose garments that are easy to put on and take off. Keep items that you need often in one place that’s easy to reach. Ask for help mov­ing things around in your house so that you won’t need to climb stairs as often. Find simple ways to cook, clean, and do other chores. For example, you can use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. De­pending on how severe your disease is, you may want to ask your family and friends for help with daily tasks.

Be prepared for emergencies.
If you have COPD, know when and where to seek help for your symptoms. Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have directions to your doctor’s office and the hospital, as well as a list of all the medicines you’re taking.

Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or ad­just your treatments to relieve and treat symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talk­ing. You also should seek emergency care if your lips or fingernails turn blue or gray (a sign of a low oxygen level in your blood), you’re not mentally alert, your heartbeat is very fast, or the rec­ommended treatment for the symptoms that are getting worse isn’t working.

Seek support for emotional issues.
Living with COPD may cause fear, anx­iety, depression, and stress. Talk with your healthcare team about how you feel. You also might consider talking to a professional counselor. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a support group is another option that can help you adjust to living with COPD. You can see how other people who have the same symptoms have coped with them. Ask your doctor about local support groups, or check with a medical center in your area.

Support from family and friends can help relieve stress and anxiety as well. Let your loved ones know how you feel and what they can do to help you.

Can’t Concentrate?

Your Allergies May Be to Blame

Sneezing, wheezing, watery eyes, and a runny nose aren’t the only symptoms of allergic diseases. Many people with allergic rhinitis also report feeling “slower” and drowsy. When their allergies are acting up, they have trouble concentrating and remembering.

For instance, allergic rhinitis can be associated with decreased ability to con­centrate and function, activity limitation, decreased decision-making capacity, im­paired hand-eye coordination, problems remembering things, irritability, sleep disorders, fatigue, missed days at work or school, more motor vehicle accidents, and more school or work injuries.

Many parents of children with allergic rhinitis observe increased bad moods and irritability in their child’s behavior during the allergy season. Since children cannot always express their uncomfort­able or painful symptoms verbally, they may express their discomfort by acting up at school and at home. In addition, some kids feel that having an allergic disease is a stigma that separates them from other kids.

It is important that the irritability
or other symptoms caused by nasal
allergies not be mistaken for attention deficit disorder. With proper treatment, symptoms can be kept under control and disruptions in learning and behav­ior can be avoided.

Causes
Experts believe the top two culprits contributing to cognitive impair­ment of people with allergic rhinitis are sleep interruptions and sedating anti-histamine (over-the-counter) medications.

Secondary factors, such as blockage of the Eustachian tube (ear canal), also can cause hearing problems that have
a negative impact on learning and com­prehension. Constant nose blowing and coughing can interrupt concentration and the learning process, and allergy-related absences from school or work can cause people to fall behind.

Sleep Disruption
Chronic nasal
congestion can cause difficulty in breathing, especially at night. Waking is a hard-wired reflex to make you start breathing again. If you have bad aller­gic rhinitis, you may waken a dozen times a night. Falling back asleep can be difficult, cutting your total number of sleep hours short.

The average person needs about eight hours of sleep per night to function normally the next day. Losing just a few hours of sleep can lead to a significant decrease in your ability to function. Prolonged loss of sleep can cause dif­ficulty in concentration and ability to remember things, and can contribute to automotive accidents. Night after night of interrupted sleep can cause serious decreases in learning ability and perfor­mance in school or on the job.

Over-the-Counter Medications
Most allergy therapies don’t take into account the effects of allergic rhinitis on mental functioning – they treat the more obvious physical symptoms. Some allergy ther­apies may even cause some cognitive or mental impairment. The most com­monly used over-the-counter medications for allergy symptoms are decongestants and first-generation antihistamines, such as diphenhydramine (Benadryl), both of which can cause sleep disturbances.

Decongestants constrict small blood vessels in the nose. This opens the nasal passageways and lets you breathe easier. Some decongestants are available over the counter, while higher strength for­mulas are available with a prescription. In some people, oral decongestants can cause problems with getting to sleep, appetite loss, and irritability, which can contribute to allergy problems. If you have any of these symptoms, discuss them with your doctor.

Antihistamines block the effects of histamine, a chemical produced by the body in response to allergens. Histamine is responsible for the symptoms of allergic rhinitis. First-generation over-the-counter antihistamines available in the United States also can cause drowsiness.
Regularly taking over-the-counter
antihistamines can lead to a feeling
of constant sluggishness, affecting
learning, memory, and performance.
Newer second-generation anti-
histamines are designed to minimize drowsiness while still blocking the
effects of histamine.

Solutions
The best way to control your symptoms is to avoid your triggers. This is often easier said than done. If your allergens can’t be avoided, your allergist can help you create an allergy treatment plan. Several types of non-sedating medications are available to help control allergies. If medications are not effective or cause unwanted side
effects, your allergist may suggest
immunotherapy (allergy shots). This therapy is used to treat allergy to pollen, ragweed, dust mites, animal dander, and other allergens, gradually desensitizing you to these substances by changing the way your body’s immune system responds to them.

If allergies are affecting your ability to concentrate or function, several treat­ment options may be beneficial. Getting allergy symptoms under control can help you sleep at night and function during the day.

If you suspect that you or a family member may have an allergic disorder, make an appointment with an allergist for proper diagnosis. Treating allergies sooner rather than later can help prevent disruptions in learning and behavior.

Get the Facts on Exercise-Induced Asthma

Then Get Moving!

Whether you are training for the next Winter Olympics or enjoying winter sports on your own, exercise-induced broncho­constriction should not force you to be a spectator in your favorite sporting activities.

Exercise-induced bronchoconstric­tion, also called exercise-induced asthma, is a narrowing of the airways in the lungs that is triggered by physical ac­tivity. An estimated 300 million people worldwide have asthma, according to the World Health Organization, and strenuous exercise can make it worse.

EIB is common in people with chronic asthma, who frequently experi­ence flare-ups while exercising. But it can also occur in otherwise healthy
individuals who experience asthma symptoms only when they exercise. People with allergies may also have trouble breathing during exercise.

Symptoms
If you have EIB, you may have problems breathing within
5 to 20 minutes after exercise. Symp­toms of EIB are similar to those of chronic asthma, but the timing of the symptoms is closely linked with physi­cal activity. Your symptoms may include wheezing, tight chest, cough, shortness of breath, and, rarely, chest pain.

People with EIB are still able to exercise – and should exercise regularly.

Triggers
People with EIB are
typically very sensitive to both low temperatures and dry air. Air is usually warmed and humidified by the nose, but during demanding activity, people breathe more through their mouths. This allows cold, dry air to reach your lower airways and your lungs without passing through your nose, triggering asthma symptoms. Air pollutants, high pollen levels, and viral respiratory
infections may also be triggers. Other causes of symptoms while exercising include being out of shape, poorly
controlled nasal allergies, or vocal
cord issues.

Diagnosis
Your physician will
begin by getting your health history, conducting a physical examination,
and performing a breathing test called spirometry. If your breathing test shows that you might have asthma, your phy­sician may give you a drug to inhale, such as albuterol. If your breathing
test numbers improve after inhaling
the medicine, then the diagnosis of asthma is more likely.

You may be asked to take an addi­tional test, called a bronchoprovocation challenge test. Your physician will have you exercise in the sport you play, run outside, or have you cycle or run on a treadmill. Before and after the exercise, your physician will test the amount of air you force out of your lungs with a spirometry test. If you exhale air less forcefully after exercise, the problem may be EIB.

Exercising with EIB
People with EIB are still able to exercise – and should exercise regularly. But you need to be sure that you are doing the right kind and right amount of exercise.

If you have been diagnosed with EIB, talk with your doctor before you begin an exercise program. Together, you can develop a management plan that will allow you to participate in activi­ties with minimal asthma symptoms.

To prevent asthma flare-ups, your doctor may prescribe that you take an inhaled short-acting medication prior
to exercise. These medications are
effective in preventing EIB symptoms in 80 to 90 percent of people with the condition. Drinking water, warming
up, and cooling down as part of your exercise routine can also help mini­mize EIB.

The sport you choose can affect your symptoms. Swimming is considered less likely to cause asthma symptoms because the warm, humid environment of the pool does not
aggravate the airways. Hiking, walk­ing, and leisure biking are also good sporting activities for people with EIB. Team sports that require short bursts
of energy, such as baseball, football, and short-term track and field, are less likely to cause symptoms than sports that have a lot of ongoing activity, such as soccer, basketball, field hockey, and long-distance running. Cold weather activities like cross-country skiing and ice hockey are more likely to make symptoms worse, but with proper diag­nosis and treatment, many people with EIB can participate and excel in almost any sport or activity.

Exercise is important and provides many health benefits, especially for people with asthma. So don’t give up on an active lifestyle.

Cozy Up to an Allergy-Friendly Home

Tips for Preparing Your Home for Indoor Winter Living

Millions of people experience allergy symptoms caused by indoor allergens. These culprits include dust mite droppings, animal dan­der, cockroach droppings, and molds. While avoiding allergens is the most effective treatment approach, strict avoid­ance isn’t always possible. This winter, as temperatures drop and you begin spending more time indoors, consider making the following changes to mini­mize your allergy symptoms.

Dust Mites
Dust mite allergens are a common trigger of allergy and asthma symptoms. While they can be found throughout the house, these microscopic creatures thrive in warm, humid environ­ments, such as bedding, upholstered furniture, and carpeting.

Because so much time is spent in the bedroom, it is essential to reduce mite levels there. Encase mattresses, box springs, and pillows in special
allergen-proof fabric covers or airtight, zippered plastic covers. Bedding should be washed weekly in hot water (130 de­grees Fahrenheit) and dried in a hot dryer. Allergen-proof covers are avail­able for comforters and pillows that can’t be regularly washed.

Keep humidity low by using a dehu­midifier or air conditioning. Wall-to-wall carpeting should be removed as much as possible. Instead, throw rugs may
be used if they are regularly washed
or dry cleaned.

Pet Allergens
Contrary to popular opinion, there are no “hypoallergenic” breeds of dogs or cats. That is because people are not allergic to an animal’s hair, but to an allergen found in the sa­liva, dander (dead skin flakes), or urine of an animal with fur.

Pet allergy symptoms typically occur within minutes. For some people, symp­toms build and become most severe eight to twelve hours after contact with the animal. People with severe allergies can experience reactions in public places if dander has been transported on pet owners’ clothing.

Keeping an animal outdoors is only a partial solution, since homes with pets in the yard still have higher concentrations of animal allergens. Before getting a pet, ask your doctor to determine if you are allergic to animals. If your pet is already considered part of your family, try to minimize contact and keep the pet out of the bedroom and other rooms where you spend a great deal of time. Vacuum carpets often or replace carpet with a hardwood floor, tile, or linoleum.

While dander and saliva are the source of cat and dog allergens, urine is the source of allergens from rabbits, ham­sters, mice, and guinea pigs, so ask a non-allergic family member to clean the animal’s cage.

If you have a pet allergy, talk to your doctor about the potential for allergy
immunotherapy. This strategy can often provide long-term relief.

Cockroaches
Cockroaches are often found in the homes of densely populated urban areas, schools, or commercial buildings, but these creatures can lurk almost anywhere. This does not mean that you have a dirty house or living area.

Block all areas where roaches can enter the home. This includes crevices, wall cracks, and windows. Cockroaches need water to survive, so fix and seal all leaky faucets and pipes. Have an exter­minator go through the house when your family and pets are gone to eliminate any remaining roaches.

Keep food in lidded containers, and put pet food dishes away after your pets are done eating. Vacuum and sweep the floor after meals, and take out garbage and recyclables. Use lidded garbage containers in the kitchen. Wash dishes immediately after use, and clean under stoves, refrigerators, or toasters where crumbs can accumulate. Wipe off the stove and other kitchen surfaces and cupboards regularly.

Mold
Indoor molds and mildew need dampness, typically found in basements, bathrooms, or anywhere with leaks. Get rid of mold growth on hard surfaces with water, detergent, and, if necessary, five percent bleach (do not mix with other cleaners). Then dry the area completely. If mold covers an area more than 10 square feet, consider hiring an indoor environmental professional. For cloth­ing, washing with soap and water is best. If moldy items cannot be cleaned and dried, throw them away.

Repair and seal leaking roofs or pipes. Using dehumidifiers in damp basements may be helpful, but empty the water and clean units regularly to prevent mildew from forming. All rooms, especially basements, bathrooms, and kitchens, require ventilation and cleaning to
deter mold and mildew growth. Avoid carpeting on concrete or damp floors and storing items in damp areas.

The Most Wonderful Time of the Year?

Not if You Spend it Sneezing & Wheezing

You don’t want to be a Scrooge. You really don’t. But every holi­day season you wonder why your “seasonal” allergies are still bothering you. Why are you stuck sneezing, wheez­ing, and coughing while everyone else is caroling, sleighing, and spreading cheer?

“People don’t realize how many hidden triggers are associated with the holidays and winter season,” says aller­gist James Sublett, md, president of the American College of Allergy, Asthma & Immunology. “Those who suffer from allergies and asthma assume things will ease up once the cold weather hits, but there are other factors which can cause your allergies and asthma to flare. In fact, two thirds of allergy sufferers have year-round triggers and symptoms.”

If the first frost has come and gone but you’re still dealing with seasonal allergies and asthma flares, the follow­ing tips can help you get through the cold-weather holidays with nary a
“bah humbug.”

Skip the Seasonal Scents
Many people use candles during the holidays, but scented candles can trigger symp­toms in people with allergies and asthma. Wood-burning fireplaces are also a
trigger, as well as aerosols, such as air fresheners and artificial snow. Avoid potpourri and other scents designed to make your house smell good. They might also cause sneezing and sniffling among your guests.

A Feast without Fear
Traditional holiday foods are often a big part of sea­sonal gatherings, including Hanukkah, Christmas, and Kwanzaa; however, some of those dishes may contain potential food allergens. If you have a history
of possible food allergies, consult with your doctor to determine if you’re
actually allergic or if you’re just intol­erant. If you’re dining at a friend’s house, let your host know about your food allergy, and bring a dish to share that
is safe for you to eat. If you’re the host, check labels for common food allergens, and consider putting small labels on foods that contain peanuts, tree nuts,
or shellfish, as these are the most com­mon holiday food allergens.

Tip: When people gather, viral
illnesses are more likely to be passed around. If you have
asthma, talk to your doctor
about getting a flu shot.

Coughin’ around the Christmas Tree
Both live and artificial trees can trigger symptoms. Some people are allergic to terpene, found in the oil or sap of trees. Others are bothered by mold spores or pollen brought in by fresh trees and greenery. Before bringing them into your house, use a leaf blower to help remove some of the pollen. Wash live trees, especially the trunk, with a garden hose and leave in the garage or on
a covered porch to dry. Wear gloves when handling the tree to avoid sap. Artificial trees can harbor dust and mold if stored improperly, so you should wash these trees outside as
well to help eliminate some of the
allergens. When storing the tree, place it in an airtight container to hinder
allergen accumulation.

Ditch the Dust, Then Deck the Halls
Seasonal decorations stored in attics and basements for months often gather dust and mold, which can trigger an allergic reaction when they come out
of storage. Clean each item thoroughly before decking the halls, dining room, or tree. After the holidays, when you’re packing decorations away, store them in airtight containers.

Baby, It’s Cold Outside
You may want to exercise to keep holiday pounds away, but exercising in the cold can make asthma symptoms worse. The symptoms of asthma include coughing, wheezing, a feeling of tightness in the chest, and shortness of breath. If these symptoms occur when you exercise
in cold weather, they may indicate
undiagnosed asthma. An allergist can perform lung function tests to accu­rately diagnose asthma and create an action plan to help identify your trig­gers, as well as ways to avoid them. For example:

Warm up with gentle exercises for about 15 minutes before you start more intense exercise.

Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.

Take medicine as recommended
by your doctor to prevent and treat your asthma.

Consider moving your exercise
program indoors if the temperature
is below freezing.

You Better Watch Out
While stress doesn’t cause allergies or asthma, it can hinder your immune system. The chaos of the holiday season also may distract you from keeping yourself healthy, in­cluding taking your allergy and asthma medication. Carve out time to stay on top of your symptoms so illness doesn’t derail your holiday plans.

Coping with COPD

It’s a Family Affair

A diagnosis of chronic obstructive pulmonary disease can seem like devastating news. A life with COPD is different from a life without COPD, and coping with these changes is a significant challenge to overcome. The good news is that peo­ple with COPD can continue to live active, full lives.

COPD and Your Family While you may be the one with COPD, everyone who loves you is also affected by the illness. Your loved ones hate to see you uncomfortable and unable to do the things they know you enjoy. In addition, stress levels can rise as roles change and your family re-evaluates its goals and plans. When challenges arise,
having an understanding of the best methods for coping with them can
help you and your family deal with
the stresses of COPD.

Challenges and Coping Methods The challenges of COPD typically
begin long before the diagnosis. How­ever, when you find out for sure that you have COPD, you will likely experience difficult emotions, such as sadness, fear, anger, guilt, and worry. Share these feelings with your loved ones. Discuss how the diagnosis may change your lives, and then plan how to pursue treatment as a team.

♦
Acute Challenges
One type of chal­lenge you may face is an acute challenge. This is when something happens sud­denly that makes your situation worse. Examples of acute challenges include disease exacerbations, such as lung
infections, or trips to the emergency room due to some source of unusual excitement or anxiety. In these situa­tions, you and your family members should rally together to support each other. Usually, a short burst of extra effort by you and by your support net­work can resolve an acute challenge.

♦
Chronic Challenges
The second
type of challenge is a chronic challenge, a long-standing, slowly progressive problem that is not likely to go away. Familial role changes are a chronic chal­lenge that can lead to frustration and guilt. You may find it difficult to accept role changes, for instance, if you’re not able to shop or cook for your family like you used to; do as many household chores, like cleaning, yard work, or shov­eling snow; or entertain over the holidays in as elaborate a fashion as in previous years. Having to carry supplemental oxygen and managing medications can also be chronic challenges.

For chronic challenges, the better coping response may be to understand what the situation has meant for you and your family. Once you determine the impact of the situation, try to find
a way to recover the value of what was lost rather than the ability to do that exact same activity. Be proactive and creative. For example, if you can’t ski together as a family anymore, maybe you can enjoy family walks. If not walks, perhaps scheduled dinners or game nights will make up for the lost family bonding time.

Managing Your COPD Together Long Term
Over time, managing your COPD will require both types of response – sometimes for the same situation. For instance, if you become acutely ill at
a family event, it may require an acute response, maybe even a trip to the emer­gency room. Not only will the family be concerned about your well-being, but also you will all be dealing with the dis­appointment of having to cut short your time together. Once the immediate crisis has passed, you and your family will need to come up with a chronic response to the crisis. Work together to decide what long-term changes can be made in order to avoid similar crises in the future.

There’s Nothing Wrong with Needing Help

With COPD, you may feel less able
to do many of the tasks that you have always done for yourself. You may feel that you’re not “pulling your weight.” The amount of support you need from time
to time may differ, but it’s important to recognize that you do need help. Finding and accepting that help is an essential part of caring for yourself. Take some time to think about the following questions:
⇒ Is there someone who has been
trying to help that you’ve turned down?
⇒ Have you thanked those who have helped or are helping you? Can you think of a new way to say thanks?
⇒ What makes it hard for you to ask for or accept help from others?
⇒ Can you think of some other sources of support you haven’t utilized? How about support groups? Extended family? Religious community?

You may be the one with COPD, but everyone who loves you and is involved in your life is also affected by your dis­ease. They care about you and want to help make your life easier. By allowing the people around you to help, you
will feel better because you have more choices, and they will feel better because you’re doing better.

Do You Know What Makes Your Asthma Worse?

An asthma trigger is anything that makes your asthma worse. When you encoun­ter one of your triggers, it can cause a sudden worsening of asthma symptoms, which is often called an asthma attack, episode, or flare-up.

Knowing what causes your asthma symptoms is an important step to con­trolling your asthma. Common asthma triggers include respiratory infections, allergens, irritants, exercise, and strong emotions. Your doctor can help you identify what makes your asthma worse. Once you know what causes your symp­toms, you can work with your doctor to come up with a plan for managing your asthma and avoiding your triggers.

Here’s a breakdown of the most com­mon asthma triggers, along with some tips for reducing your exposure to them.

Medical Conditions Respiratory infections, such as a cold, flu, or sinus infection, are the most common cause of asthma symptoms leading to an asthma flare-up. Washing your hands frequently and avoiding people who are sick will help to reduce your exposure to cold and flu. However, the best way to prevent the flu is to get a flu vaccine every year. Pregnancy hormones and other medical conditions, such as acid reflux, can also worsen asthma symptoms.

Food & Medicines Asthma can be triggered by food allergies and certain medications. Discuss with your doctor any over-the-counter or prescription medicines you take,
such as aspirin, fever-reducers, or
anti-inflammatories, as well as any
alternative therapies or herbal remedies you use, as they may have an impact on your asthma.

Smoke All types of smoke can make it hard to breathe, including smoke from wood-burning fireplaces, campfires, burning leaves, cigarettes, cigars, and pipes. If you smoke, you should make a plan to quit. If you don’t smoke but live with someone who does, ask that he or she smoke outside, and discuss other ways to prevent or limit your exposure to tobacco smoke.

Weather, Pollen, & Air Pollution Changes in the season can bring on
an asthma episode due to increased pollen in the air. Limit your time outdoors when pollen counts are high, especially during spring and fall. Extreme temperatures; cold, windy, or stormy weather; high humidity; and air pollution, including smog, vehicle ex­haust, and other fumes, can also cause problems for asthma fighters. Be pre­pared for the weather and outdoor air conditions before you leave your home by checking the pollen counts and air quality index for your area.

Animals Dander and saliva from animals with fur or feathers – includ­ing cats, dogs, ferrets, hamsters, Guinea pigs, bunnies, mice, and birds – are common allergy trig­gers, and for some people, they can cause asthma symptoms. Reduce your expo­sure to pet allergens by vacuuming and damp dusting weekly. Try to keep your pets out of your bedroom and any other rooms where you spend a lot of time.

Pests Dust mites, cockroaches, and rodents aren’t just annoying; these little guys, which can be found in your home, workplace, and school, can trigger asthma symp­toms. To reduce your exposure to these trig­gers, wash bedding regularly, fix leaks, store garbage outside, vacuum and dust weekly, and use allergen-proof
pillow and mattress covers.

Mold Mold is another common
allergen that can trigger asthma symp­toms. You can reduce your exposure to mold
by cleaning any visible mold in your home with mild soap, hot water, and a strong brush. Throw away moldy items that cannot be cleaned. To help prevent future mold growth, run a dehumidifier, fix leaking pipes and faucets, and turn on the ex­haust fan when you take a shower.

Exercise Staying active is very
important to your overall health and well-being, especially
for people with asthma.
If you know that exercising or playing sports triggers your asthma symptoms, use your quick-relief medicine 15 to 30 minutes before engaging in physical activity, if prescribed. Remember to monitor the local air quality if you
plan to exercise or play outside.

Emotions Emotional ups and downs are part of life. But before you lose your composure, remember that strong emotions can increase rapid breathing and trigger asthma symp­toms. Stress, both personal and work related, can be a major trigger as well. The same goes for laughing or crying too hard, yelling, and feeling anxious, angry, and afraid.

Strong Odors Scents from perfumes, deodorants, and cleaning supplies can leave you gasping for air. Scents from gas stoves, scented candles, incense, hairspray, and air freshen­ers can also cause asthma symptoms. When possible, choose cleaning and personal care products that are both odor- and fragrance-free.

For more information on lung health, visit
lung.org or call the American Lung Association’s Lung HelpLine at (800) 586-4872 to speak with
a lung health expert.

NFL Legend Jerome Bettis

Gives the Play-by-Play on Managing His Asthma & Severe Food Allergies

by Jessica Webb Errickson

As one of the most celebrated players in NFL history, former Pittsburgh Steeler Jerome Bettis knows the importance of staying at the top of his game. For Jerome, whose impressive rushing skills earned him the nickname “The Bus,” keeping in tiptop shape demands more than a healthy diet and exercise routine; he also has to contend with asthma and severe food allergies. But with his asthma under control and his anaphylaxis action plan in place, nothing can stop “The Bus.”

Many years before leading his team to Super Bowl XL victory, 14-year-old Jerome was enjoying some Chinese food with his aunt and uncle when he first experienced anaphylaxis, a life-threatening allergic reaction.

“I ordered shrimp fried rice, and as I was eating it, my throat started to itch. A couple of seconds later, I could feel my throat starting to close up,” Jerome explains in an interview with Coping magazine. “I was familiar with that type of feeling because I have asthma, so it was clear that something was wrong.
It didn’t feel like an asthma attack, but I knew I needed to get help immediately. My aunt and uncle rushed me to the hospital, where I was injected with
epinephrine. That’s when I was diag­nosed with a shellfish allergy.”
From that day forward, Jerome had to adhere to some permanent lifestyle changes to ensure his safety, especially when dining out. This is where his ana­phylaxis action plan comes into play.

"Even if you don’t have severe
allergies, by becoming educated on the condition, you could possibly save a life."

“The first step in my action plan is to avoid my allergen,” he explains. “When I’m at a restaurant, the first thing I do
is let my server know that I am allergic to shellfish. I also alert the chef. When I look at the menu, I ask about ingredi­ents and how dishes are prepared, and
I alert the staff about the possibility of cross-contamination and the importance of making sure that they don’t cook
my food in the same pan or the same grease as my allergen.”

However, when it comes to life-threatening allergies, it’s not enough to depend on the restaurant staff to keep you safe. You have to be prepared to handle a potential allergic reaction.

“I always carry two Auvi-Q epineph­rine auto-injectors,” Jerome continues. “This is paramount because I can be as diligent as possible, but someone in the kitchen or on the waitstaff could make a mistake, and I may need to use one
of my epinephrine auto-injectors. If so,
I know I have a second one available in case of a secondary reaction. I also need to get emergency help immediately.”

Jerome stresses that people should never treat these types of reactions lightly, as they can be life threatening. “If you don’t carry your epinephrine auto-injectors with you, then you put yourself in a very dangerous position,” he says

While his shellfish allergy never posed a problem on the field, the former running back, who barreled more than 13,000 yards through packs of muscle-bound defensive linemen during his 13-year career, did have to take actions to keep his asthma under control come game time.

“I’ve had an asthma attack during
a football game. That was a dangerous situation as well,” says Jerome. “After that, I used a nebulizer before every single game that I played, to open my airways and allow me to take those deep breaths you need when you’re playing football.”

Just as he is diligent about manag­ing his allergies and asthma, the football legend and current NFL analyst for ESPN, is also intent on spreading aware­ness about these conditions. Specifically, Jerome has teamed up with the Allergy and Asthma Foundation of America and the pharmaceutical company Sanofi to promote What’s Your AQ?, an educa­tional online quiz that allows participants to test their AQ, or anaphylaxis quotient.

According to Jerome, “The quiz gives you a better understanding of what
anaphylaxis is and dispels some of the misconceptions about it. Even if you don’t have severe allergies, by becom­ing educated on the condition, you could possibly save a life. There were even some things about the condition that
I didn’t know until I took the quiz.”

The main point Jerome hopes to drive home is that anaphylaxis is life threatening, so if you’re at risk for
anaphylactic reactions, you have to have a game plan.

“Have an anaphylaxis action plan – be diligent, educate yourself about severe allergies, and keep two epineph­rine auto-injectors with you at all times,” he stresses. “It could save your life.”

Say Hello to Fall

… and Goodbye to Allergy & Asthma Symptoms

With its cooler temperatures, beautiful colors, and fun activities, fall is a favorite season for many people. But the arrival of harvest season also signals the arrival of fall allergies, causing headaches, stuffy noses, and sneezing that can put a damper on fall fun. If you’re one of more than 50 million Americans with allergies and asthma, the following tips can help you find relief and enjoy fall to the fullest.

Hayrides and Hay Mazes
Contrary to what you might think, the hay used in hayrides and hay mazes doesn’t ac­tually cause hay fever (also known as allergic rhinitis). However, these activi­ties do expose you to the real culprits: outdoor allergens, with weeds (especially ragweed) and mold being the most common fall allergy triggers.
“Pollen can build up easily on bales of hay, which can then get on clothes,” says allergist Michael Foggs, md, presi­dent of the American College of Allergy, Asthma & Immunology. “If possible, take a shower, wash your hair, and change clothing after an outdoor outing such
as a hayride.”

Weeds and
mold are common
fall allergy triggers.

While it’s impossible to completely escape pollen and molds, you can take some precautions to lessen exposure:

Keep the windows in your home and car closed, and use air-conditioning,
if possible.
Remember to change your home and auto air filters regularly and replace them with high efficiency filters.
Don’t hang laundry outdoors to dry. Pollen may cling to towels and sheets.
Outdoor air usually is most heavily saturated with pollen between 5 a.m.
and 10 a.m., so limit early morning
outdoor activities. Also be aware that wind gusts and activities like raking leaves can stir up mold spores.
Wear a pollen mask when mowing the lawn, raking leaves, or gardening, and take allergy medication beforehand.

Apple Picking and Baking
Fall is a great time for picking apples and baking pies from your bounty. But if your mouth, lips, or throat gets itchy or you sniffle and sneeze after eating a raw apple, you may have oral allergy syndrome. The condition, which affects about one third of seasonal allergy fighters, causes a reaction in people who are already aller­gic to pollen when their immune system sees a similarity between the proteins of pollen and those of certain foods.

The good news is people affected
by oral allergy syndrome can usually eat cooked forms of the same fruits that cause a reaction, because heat changes the proteins. So go ahead and bake the apples into a pie without worry. But before you reach for the cinnamon, one of the key ingredients that makes apple pie so scrumptious, be aware that it can trigger an allergic reaction. Although spice allergy is very rare, it’s believed that many people with the allergy are undiagnosed. In addition to cinnamon, spice allergy triggers include garlic, black pepper, and vanilla.

Taking a Hike
The idea of taking
a fall hike and breathing in cool, crisp air is especially appealing after a long, hot summer. You just need to make sure to take the proper precautions
before hitting the trail if you have
allergies or asthma.

“Asthma triggers are things that don’t bother most people, but can make in­flamed lungs worse if you have asthma,” says Dr. Foggs. “Asthma triggers in­clude pollen, mold spores, animal fur, smoke, and dust (which can contain all of the above) – all things you could encounter while taking a hike. In addi­tion, cold, windy weather or sudden weather changes can be triggers, so asthma sufferers need to take precautions to cope with those triggers.”

Don’t wait until the first sign of symptoms to take your medications. You should start taking allergy medications at least two weeks before
your symptoms usually begin and
continue taking them for two weeks after the first frost, as your symptoms can linger after pollen is no longer
detected in the air. If you have asthma, be sure to take your controller medication as prescribed, and keep a
quick-relief inhaler with you in
case of an asthma flare.

How Asthma and COPD Can Affect Your Sleep

And What You Can Do about It

by Jay Balachandran, MD, and Mihaela Teodorescu, MD

Good quality sleep is important for everyone. However, people with asthma or chronic obstruc­tive pulmonary disease may have sleep issues that can lead to nighttime awaken­ings and daytime sleepiness. This can worsen their symptoms of asthma or COPD. Fortunately, there are a number of steps people with asthma or COPD can take to improve their sleep.

What kind of night disturbances might I experience with asthma or COPD?
Waking up at night, also called nighttime arousal or nighttime awaken­ing, can happen if you have asthma or COPD. These arousals interrupt your sleep and may cause you to feel groggy in the morning or tired during the day. Symptoms of COPD and asthma that may cause you to wake up at night
include coughing, wheezing, chest tightness, and breathlessness. People with COPD or asthma may also be
at increased risk for sleep apnea and may awaken from symptoms of this sleep problem.

What is sleep apnea? Why can I experience sleep apnea with asthma or COPD?
Sleep apnea is a condition that causes you to have periods when you stop breathing during sleep. These pauses in breathing usually last 10 sec­onds or longer. It is not clear why sleep apnea may occur more often in people with asthma or COPD, but you are more at risk if you have severe asthma, are overweight, have nasal congestion,
experience acid reflux, or use high
doses of inhaled corticosteroids.

The first step to sleeping better is to make sure that your asthma or COPD is under good control.

How do sleep problems affect my asthma or COPD?
People with asthma or COPD who have a frequent problem waking up at night often have worse respiratory disease. They are also at risk for complications from their asthma or COPD. Sleep apnea can worsen asthma symptoms throughout the day, increase your need for rescue inhalers, and worsen your quality of life. If you have COPD, the pauses in your breathing and low oxygen levels with sleep apnea can make your COPD worse and can be life threat­ening. Moreover, sleep apnea can be a serious condition by itself. People with moderate to severe sleep apnea who
do not get treatment have an increased risk for hypertension, heart disease,
and stroke.

If you have asthma or COPD,
you may be at increased risk
for sleep apnea if ...

♦ You have more frequent asthma or COPD symptoms, are over­weight, smoke, experience
nasal problems or heartburn,
or use higher doses of inhaled corticosteroids
♦ You are sleepy during the
day, even after you have slept
all night
♦ You snore or make choking noises while you sleep
♦ You have been heard having breathing pauses during sleep
♦ You wake up in the morning with headaches

What can I do to help myself sleep better?
The first step is to make sure that your asthma or COPD is under good control. Your healthcare provider can evaluate your condition to ensure that you are getting the right medical treatment and then develop a series
of steps you can take to control your asthma or COPD and guide you through an episode of sudden breathlessness. He or she will also instruct you on when to use your rescue inhaler or pursed-lip breathing technique and give you a set of questions to ask yourself about your condition should you experience any sudden breathlessness.

Also, be sure to tell your healthcare provider if you have nasal congestion or experience heartburn so you can learn how to get them under better control.
If you smoke, quitting smoking will not only help your asthma or COPD control, but the quality of your sleep will also improve. Sleep apnea is treat­able, so tell your healthcare provider if you think you may have this condition so you can be evaluated.

Dr. Jay Balachandran is assistant professor of medicine and associate director of the Sleep Medicine Fellowship Program at the University of Chicago Medicine in Chicago, IL. He specializes in pulmonary, critical care, and sleep medicine. Dr. Mihaela Teodorescu is an associate professor of medicine who specializes in pulmonary, critical care, and sleep medicine at the University of Wisconsin School of Medicine and Public Health in Madison, WI.

The Dish on Dining Out with Food Allergies

by Mireille Schwartz

Aside from the stunning Fog City backdrop against the Golden Gate Bridge, San Francisco is best known as a foodie haven with great local cuisine. When moving to the Bay Area more than a decade ago, I didn’t take into account the overwhelming presence of seafood in the city. Having a seafood allergy, it took some adjustments to be able to enjoy the beauty and culture and still dodge seafood, which seemed to be everywhere.

When dining out, people like me who are living with food allergies must be particularly alert to what’s on their plate. The first step to dining out safely is to perform some preliminary research. Start by calling restaurants you’d like to try in your area. Investigate restaurants’ web­sites and look for either a menu listing ingredients or an email address where you can ask for information about spe­cific recipes.

If you want to find out a restaurant’s policy on serving diners with food aller­gies, you’ll need to call the place well ahead of your din­ner date. Be sure to provide as much notice as possible so the staff will have enough time to assess if they can keep you safe. It’s good to call at the beginning of the workday, long before the hectic lunch rush begins and the end-of-evening fatigue sets in. Another good time to call is be­tween 2 and 4 p.m., after lunch but before the dinner rush. The following are exam­ples of questions to ask when you call:

Do you have a formal allergy policy? Is the wait staff educated and trained in handling food allergies?

Do you have a book or list of the ingredients in all the foods you serve?

Will you custom prepare a meal for a food-allergic individual?

How is your kitchen laid out?

What kind of oil is used in the fryer? What else is fried in it?

Do you have dedicated cooking
surfaces that are kept safe for food-allergic cooking?

Are cooking utensils for different foods kept separate and safe?

Does the wait staff know to keep dishes containing food allergies away from other dishes? Do they know that allergens can’t just be picked off a meal?

When you’re looking over the menu, be mindful of hidden allergens lurking in breading, salad dressing, complex sauces, garnishes, and certain courses.

Mireille Schwartz

If you’re not satisfied with any an­swer you’re given, ask to speak to the manager or the chef, as they have more intimate knowledge of the many aspects of food service. If you’re still not sat­isfied, continue to search for a safe restaurant in which to dine. It’s better to be told no by a restaurant after they have assessed their ability to cope with food allergies than to get a rushed, half­way yes and then succumb to your food allergy in the dining room.

When you arrive at the restaurant, make sure to meet the manager and
explain your condition thoroughly.
Tell the manager that you would like
to brief your designated waiter about your food allergy once you are seated – he or she will be your liaison with
the kitchen.

When you’re looking over the menu, be mindful of hidden allergens lurking in breading, salad dressing, complex sauces, garnishes, and certain courses. Sometimes ingredients are listed by alternate names. So if you request that something be left out of a dish, it’s vital to know all the terms, including deriva­tives, under which your allergen may be listed.

I always check with the wait staff and chef to ensure fish is not cooked
in the same skillet or in the same oil as other food items. It’s also good to make sure your dishes are not prepared with the same utensils or on the same work surfaces as your allergen or you will
be subject to cross-contamination or cross-contact. One savvy chef taught me years ago to tell a waiter, “I am
also severely allergic to utensils that have touched fish.”

However, two avenues of cross-contact are difficult to avoid. The first is restaurant grills. Always inquire whether a food marinated in an allergen is cooked directly on the same grill as any grilled dish you may want to order. The second is frying oil. If you are allergic to some­thing cooked in a deep fryer, you have to avoid eating anything else fried in that oil.

When your meal arrives, trust your instincts. If you have doubts about
your order after you’ve received it, it’s perfectly fine to politely ask your waiter
to double check with the kitchen. Then don’t feel shy or embarrassed about sending food back if a mistake has been made, as simply removing the allergenic items from your plate isn’t sufficient to keep you safe. You should also be sure to have an emergency plan in place in case an allergic reaction occurs.

Food allergy fighter Mireille Schwartz is CEO and founder of the Bay Area Allergy Advisory Board, AllergySF.com. This article is excerpted from her book The Family Food Allergy Book.

This article was originally published in Coping® with Allergies & Asthma magazine,
Spring/Summer
2014.

Separating Allergy Fact from Fiction

The Greatest Allergy Myths and Misconceptions, Debunked

From gluten allergy and hypoaller­genic pets, to avoiding the flu shot because of an egg allergy, there are a lot of common myths and miscon­ceptions about allergies. Many might be shocking due to a great deal of false information in the media and on the Internet. And some of the misconcep­tions can be damaging to your health
if vaccinations are skipped and extreme dietary avoidances are taken.

Where did all these misconceptions come from? According to a presentation given at the 70th Annual Scientific Meet­ing of the American College of Allergy, Asthma & Immunology, previously held medical beliefs and public perception are partially to blame.

“Many early medical beliefs have been proven to be incorrect as research has advanced,” says allergist David Stukus, MD, ACAAI member and pre­senter. “Unfortunately, some of these beliefs are still on the Internet, where an astonishing 72 percent of users turn to for health information.”

At-home allergy screening tests are
not reliable and can often lead to
misinterpretation, diagnostic confusion,
and unnecessary dietary elimination.

According to Dr. Stukus, the fol­lowing are some of the greatest allergy myths:

♣
I’m Allergic to Artificial Dyes
There is no scientific evidence to support a link between exposure to artificial coloring and allergies. Controversy exists regarding evidence for artificial color­ing and behavioral changes in children, as well as dyes causing chronic urticaria and asthma.

♣
I Can’t Have Vaccines Due to an Egg Allergy
Egg embryos are used to grow viruses for vaccines such as the flu, yellow fever, and rabies shot. However, it’s now safe for egg-allergic individuals to get the flu shot, which can help prevent serious illness.

♣
At-Home Blood Tests Reveal What You’re Allergic To
These tests might be able to reveal sensitization, but be­ing sensitized to a certain allergen, like milk, doesn’t mean you’re allergic to
it. These sort of at-home screening tests are not reliable and can often lead to misinterpretation, diagnostic confusion, and unnecessary dietary elimination.

♣
Highly Allergenic Foods Shouldn’t Be Given to Children until 12 Months of Age
For most children, there is no evidence to support avoidance of highly allergenic foods past four to six months of age. Emerging evidence shows that early introduction of highly allergenic foods may actually promote tolerance.

♣
I’m Allergic to Cats and Dogs, but
I Can Have a Hypoallergenic Breed
Unfortunately, there is no such thing
as a truly hypoallergenic dog or cat. Allergens are released in saliva, seba­ceous glands, and perianal glands; it’s not the animals’ fur that people are al­lergic to. However, it is true that some breeds are more bothersome for allergy fighters than others.

♣
I’m Allergic to Shellfish and Can’t Have Iodine Imaging
Radiologists
and cardiologists often use iodinated contrast for better imaging during CT scans and other procedures. Since shellfish contain iodine, many physi­cians have linked a contrast reaction
to shellfish allergy. However, this is false, and a shellfish allergy has noth­ing to do with the reaction. In fact, iodine is not and cannot be an allergen, as it is found in the human body.

♣
I Can’t Eat Bread – I’m Allergic to Gluten
You may have a gluten intoler­ance, but it’s extremely rare to have a true allergy. Most allergic reactions to these types of foods stem from wheat allergy. Many people self-label as
having gluten allergy and avoid gluten without any medical indication.

With information being widespread online and via social media portals, how can you know what to believe
and what not to believe? “If you think you may have an allergy, you should see a board-certified allergist for
proper evaluation, testing, diagnosis, and treatment,” says Dr. Stukus.
“Misdiagnosis and inappropriate
treatment can be dangerous.”

Kids Can Breathe Easy at Asthma Camp

by Cynthia Isaacson, MA

Both parents and their kids with asthma can breathe easy this summer knowing they will be well taken care of at asthma camp. Asthma camps are exclusively for chil­dren and teens with persistent asthma, meaning they take daily controller medication. Many of the kids who go to asthma camp are unable to attend a “mainstream” camp because of their chronic disease, required daily medica­tions, or their parents’ discomfort with not knowing the level of care their child will
receive away from home.

Asthma camps are organized and staffed around-the-clock by highly trained medical professionals, including specialists, physi­cians, nurses, and respiratory therapists, to ensure that each camper’s asthma is well managed. These camps take added steps
to remove, or help children avoid, asthma triggers. Asthma camps allow campers to connect with other kids just like them and experience fun outdoor activities in a safe environment. Recreation varies at each
camp, but many offer activities such as
swimming, canoeing, kayaking, arts and crafts, outdoor cooking, archery, ropes
courses, team sports, and nature walks.

Asthma camps allow
campers to connect with
other kids just like them
and experience fun
outdoor activities in a
safe environment.

Cynthia Isaacson

Researchers have found that children
who attended asthma camps, either day or overnight camps, were more likely to use their daily controller medication. In addition, children who attended asthma camps were
33 percent less likely
to be hospitalized for asthma in the following year than children with asthma who did
not attend camp. Why? At asthma camp, campers learn about their chronic disease as well as how to recognize signs and symptoms of a flare-up, how and when to take their medications, and how to safely participate in all activities despite
their asthma.

Find an Asthma Camp Near You

Registration is open for your child to
attend an asthma camp this summer, and
the Consortium on Children’s Asthma Camps can help locate a camp near you. The Con­sortium is a national coalition of around 100 asthma camps that promotes high-quality medical care at existing asthma camps,
provides parameters for asthma education, promotes the development of new asthma camps, and develops initiatives to target high-risk children and give them the opportunity to attend asthma camp. To find a
camp in your area, go to the Consortium’s website at AsthmaCamps.org, and click
find a camp. More information about camp activities, packing lists, and dates are avail­able on each camp’s website, and financial assistance may be available. If you’d like more details on a particular camp, contact that camp’s coordinator.

Campers’ parents appreciate the positive impact that asthma camp has on their chil­dren’s lives. According to one camper’s parent, “Camp is a place where a child with asthma can still be a child. You don’t have
to be concerned, because you know the kids are well taken care of. Camp helped my son improve his asthma care. They showed him proper medication techniques and got him on a regular schedule for taking his medications. He takes his medication himself now.”

Importantly, campers love the experience too. One camper in particular, Matthew,
was a shy, reserved child with asthma whose symptoms had kept him from getting involved in sports and other activities, making him feel like an outsider. Matthew attended asthma camp for the first time in 2011. During camp, he learned how to keep his asthma under
control by taking his controller medication every day and using the correct technique. With his asthma under control, he no longer had to sit on the sidelines. After camp, he
enrolled in tae kwon do. By his third year of camp, Matthew was an outgoing kid showing leadership with the younger campers. He’s now a black belt in tae kwon do.

Cynthia Isaacson is the manager of communica­tions for the Consortium of Children’s Asthma Camps. She also organizes Camp Superkids,
a camp for kids with asthma in Loretto, MN, through the American Lung Association
in Minnesota.

This article was originally published in Coping® with Allergies & Asthma magazine,
Spring/Summer
2014.

Skip the Allergies, Not the Fun

Get Relief from Your Allergy Symptoms & Enjoy the Warm Weather

Seasonal allergic rhinitis, often referred to as hay fever, affects millions of people worldwide. Symptoms in­clude sneezing, stuffiness, a runny nose, and itchiness in the nose, roof of the mouth, throat, eyes, or ears. These allergic reactions are most commonly caused by pollen and mold spores in the air, which start a chain reaction in the immune system.

Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, your immune system identifies pollen as an invader, or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction.

Pollen
Tiny grains known as pollen are needed to fertil­ize many kinds of plants. Pollen from plants with colorful flowers, like roses, usually does not cause allergies. These plants rely on insects to transport the pollen for fertilization. However, many plants have flowers that produce powdery pollen grains that are easily spread by wind. These culprits cause allergy symptoms.

Each plant has a period of pollination that does not vary much from year to year. However, the weather can affect
the amount of pollen in the air at any time. Seasonal aller­gic rhinitis is often caused by tree pollen in the early spring. During the late spring and early summer, grass pollen
often causes symptoms. Late summer and fall hay fever
is caused by weed pollen. In warmer places, pollination
can be year-round.

During the late spring and early
summer, grass pollen often causes allergy symptoms.

Mold
Molds are tiny fungi related to mushrooms but with­out stems, roots, or leaves. Molds can be almost anywhere, including soil, plants, and rotting wood. Their spores float
in the air, much like pollen. Outdoor mold spores begin to increase as temperatures rise in the spring. In the United States, mold spores reach their peak in July in warmer states and October in the colder states. Molds can be found year-round in the South and on the West Coast.

Pollen and Mold Levels
Pollen and mold counts measure the amount of allergens present in the air. The relationship between pollen and mold levels and your hay fever symptoms can be complex. Your symptoms may be affected by recent contact with other allergens, the amount of pollen exposure, and your sensitivity to pollen and mold. Before heading out­side, you can check pollen and mold counts for your area at the National Allergy Bureau’s website, aaaai.org/nab.

Effects of Weather and Location
Hay fever symptoms are often less prominent on rainy, cloudy, or windless days because pollen doesn’t move around during these conditions. Pollen tends to travel more during hot, dry, and windy weather, causing increased allergy symptoms.

Some people think that moving to another area of the country may help to lessen their symptoms. However, many types of pollen (especially grasses) and molds are common to most plant zones, so moving to escape your allergies is not recommended. Also, you are likely to find new allergens to react to in new environments.

Treatment
If your seasonal allergy symptoms are making you miserable, see your doctor to determine which allergens are causing your symptoms. This information will form the basis of a treatment plan to help you feel better. Your per­sonalized plan will include steps to avoid contact with your allergy triggers. Your doctor may also talk to you about medications for temporary relief.

If your symptoms continue or if you have them for many months of the year, your doctor may recommend allergy immunotherapy. Immunotherapy helps your immune system become more resistant to the specific allergen and lessens your symptoms.

There are also some simple steps you can take to limit exposure to the pollen or molds that cause your symptoms:

Keep your windows closed at night, and if possible, use air conditioning, which cleans, cools, and dries the air.

Try to stay indoors when pollen or mold counts are high. If your symptoms are severe, wear a pollen mask if long periods of exposure are unavoidable. When you return in­doors, take a shower, shampoo your hair, and change clothes.

Avoid being responsible for mowing lawns or raking leaves, as this stirs up pollen and molds.

Who Gets Asthma?

Asthma is very common, affect­ing more than 26 million people in the United States, including nearly 7 million children. No one knows for sure why some people have asthma and others don’t. However, heredity can play a role. People who have family members with allergies or asthma are more likely to have asthma themselves.

Asthma can occur at any age but is more common in children than adults. In young children, boys are nearly twice as likely as girls to develop asthma, but this sex difference tends to disappear in older age groups. Obesity is a newly identified risk factor for asthma.

What causes asthma?
People
generally think of asthma in terms of episodes or attacks. Actually, the asth­matic condition is always present, but symptoms may be dormant until they’re triggered by an allergen, respiratory infection, or cold weather. Other
triggers may include aspirin, environ­mental irritants, physical exertion, and less commonly, food additives and
preservatives.

Allergens are substances that cause no problem for a majority of people but trigger an allergic reaction in susceptible individuals. Allergens are a major source of breathing problems in both children and adults. Common allergens include plant pollen (tree, grass, and weed), dander from pets and other animals, house dust mites, cockroaches, molds, and certain foods. When an allergic individual encounters one of these al­lergens, a complicated series of events causes the body to release chemicals called mediators. These mediators
often trigger asthma episodes.

Environmental irritants , such as cold air, smoke, industrial chemicals, perfume, and paint and gasoline fumes, can pro­voke asthma. They probably trigger asthma symptoms by stimulating irritant receptors in the respiratory tract. In turn, these receptors cause the muscles sur­rounding the airway to constrict, resulting in an asthma attack.

Viral respiratory infections are the leading cause of acute asthma attacks. Surprisingly, bacterial infections, with the exception of sinusitis, do not cause asthma attacks. Some people who ex­perience heartburn can have asthma symptoms when stomach acid backs
up into the esophagus.

Beta-blockers , which often are pre­scribed for high blood pressure, glaucoma, migraine headaches, and angina, are another type of medication that can cause problems. Beta-blockers can cause airway constriction, so it is important for people with asthma to consult a phy­sician about the use of these medications.

Food additives can trigger asthma; however, this is rare. The most common food triggers are sulfites, preservatives used in products such as frozen potatoes and some beers and wines.

What is the difference between allergic disease and asthma?
Asthma is inflammation and obstruction of air­flow in the bronchial tubes. Allergies are just one of the factors that can trig­ger asthma attacks. Not all people with asthma are allergic, and there are many people who have allergies but do not have asthma.

Living with Allergic Asthma?

The best defense against allergic asthma is to avoid
the allergens that cause your symptoms. Here are some steps you can take to limit exposure to your allergic triggers.

Dust Mites • Put dust-proof covers
on pillows, mattresses, and box springs. • Avoid bedding stuffed with foam rubber or kapok.• Remove or limit carpeting in the home. If possible,
replace it with hardwood, vinyl, or linoleum floors.• Vacuum the carpets you do have once or twice a
week with a cyclonic vacuum or a vacuum with a HEPA (high efficiency particulate air) filter. • Wash bedding and stuffed animals in hot water (130°F) weekly.• Use air conditioning to keep humidity low to slow down dust mite growth during warm weather.• Change air conditioning and furnace filters every three months, and use filters with
a MERV (minimum efficiency reporting value) rating of 8
to 12. • Cover windows with
washable curtains or window shades.

Pollen • Keep windows closed during pollen season. • Stay inside during midday and afternoon hours when pollen counts are highest. • Take a shower, wash your hair, and change clothing after working or playing
outdoors.

Pets• Keep the pet outdoors
or restrict it to a few rooms
in the house. At the very least, keep the pet out of
the bedroom. • Wash your hands after touching the pet. • Bathe your pet once a week to reduce dander. • Vacuum carpets once or twice a week with a cyclonic vacuum or a vacuum with
a HEPA filter.

Mold • Clean bathrooms,
kitchens, and basements regularly, and keep them
well ventilated. • Do not use humidifiers. • Use dehumidifiers in
damp areas, with the humid­ity level set for less than
50 percent but above
25 percent. Drain and
clean the unit regularly. • Clean visible mold on walls, floors, and ceilings using a 5 percent bleach solution and detergent. • Fix leaky faucets
and pipes. • Limit your number of
indoor plants, which may harbor molds in the potting soil. Also avoid dried flowers, as they may contain mold.

Spring Cleaning with Allergies & Asthma

Your Guide to Keeping Tidy and Healthy

Spring cleaning can be more than just a daunting chore for people with allergies and asthma. Dust, pet hair, and fumes from cleaning sup­plies can leave you reaching for the tissues instead of the broom. But spring cleaning can also help you avoid al­lergy symptoms.

“Thoroughly cleaning your home can help eliminate allergens and keep new ones from easily entering,” says allergist James Sublett, MD, ACAAI president-elect and past chair of the ACAAI Indoor Environment Commit­tee. “Allergy season can last all year for those sensitive to indoor allergens, but it can worsen in the spring months when pollen becomes an issue. It’s
important to remove allergens from
the home so you can lead a healthy
and active lifestyle.”

To help eliminate spring-cleaning confusion – and symptoms – here are some useful tips for removing allergens in the home while avoiding accidentally letting more in.

A Fresh Breeze Won’t Please
The first sign of balmy temperatures might give you an urge to open your windows to let in fresh scents. But this can also lead to unwanted pollen particles enter­ing the home and making you sneeze long after your spring cleaning is
complete. Before you reach for the
air fresheners and candles to get your fresh-scent fix, be aware that chemicals found in these items can spur asthma attacks. Your best option is to opt for natural aromas from the oven, or you could try an organic air freshener.

Cleaning the entire house from top to bottom may take
days ...
... but you can get
a head start by
changing your
air filters every
three months.

Rub-a-Dub-Scrub
Bathrooms, base­ments, and tiled areas can be especially prone to mold. The key to reducing mold is moisture control. Be sure to use bathroom fans, and clean up any standing water immediately. Scrub any visible mold from surfaces with deter­gent and water, and completely dry the area. You can also help ward off mold by keeping humidity in the home be­low 60 percent and cleaning gutters regularly.

Love Your Pet, Not Its Dander
After spending many days indoors during the winter, fur, saliva, and dander from your family pet are likely elevated through­out your home. Remove pet allergens by vacuuming frequently and washing upholstery, including your pet’s bed. Additionally, you should keep your
pet out of your bedroom at all times
to ensure you can sleep symptom-free.

Whole-House Deep Cleaning
Cleaning the entire house from top
to bottom may take days, but you can get a head start by changing your air filters every three months and using filters with a MERV (minimum effi­ciency reporting value) rating of 11 or 12. Also be sure to vacuum regularly
to get rid of dust mites. Use a cyclonic vacuum, which spins dust and dirt away from the floor, or a vacuum with a HEPA (high efficiency particulate
air) filter. Wash bedding and stuffed animals weekly.

Don’t Neglect the Great Outdoors
As the grass turns green and flowers bud, it’s hard to restrict your spring cleaning routine to the indoors. It’s
best to avoid being outdoors when
pollen counts are highest (midday
and afternoon hours). Remember to take your allergy medication before you go outside. When mowing and
gardening, wear gloves and an N95 particulate pollen mask. Avoid touch­ing your eyes, and wash
your hands, hair, and clothing once you go back indoors.

Even when you reduce the number of allergens in your home, allergy symptoms can still be bothersome. If you have seasonal and perennial aller­gies, you should make an appointment with a board-certified allergist, who can identify your allergy triggers and develop a treatment plan to eliminate your symptoms.

Send Your Child’s Asthma Packing!

Tips for Asthma-Friendly Travel

If your child’s asthma is well controlled, you should be able to enjoy sightseeing, hiking,
or other leisure activities.

Your child’s asthma shouldn’t stop you from planning a family vacation or sending your child to sleepover camp or on a trip with friends. With some careful preparation and com­munication, you and your child should be able to enjoy all the benefits of time away from home.

Before you travel, make sure that your child’s asthma is well controlled. If it’s been flaring up, you should check in with the doctor. Your child might need a change in medications or might need to see the doctor before leaving.

Before You Go
When packing, be sure to include your child’s rescue and controller medications. Keep them handy, not buried in the car trunk. And if you’re flying, be sure to take them
in your carry-on luggage. That way, you’ll have them if your child needs the medications during the flight or if your checked bags go astray.

You’ll also want to pack a peak flow meter (if your child uses one), health insurance cards and information, and the asthma action plan (that way you’ll have the names of medicines, dosage information, and your doctor’s phone number, just in case).

If you’re traveling abroad, consider taking a letter from the doctor that
describes your child’s diagnosis, medi­cations, and equipment. This can help you with airport security or customs. It’s also smart to have the generic names of all medicines, in case they’re called something else in another country.

If your child uses a nebulizer, you might want to invest in a portable ver­sion. Many of these can be plugged into the cigarette lighter in a car. If you’ll
be traveling abroad, make sure you have the adapter you need to use it.

Rolling Along
Buses, trains, and cars may contain many of the same poten­tial allergens as your home, including dust mites and mold that are trapped in the upholstery or the ventilation system. You can’t do much about the bus or train, but if you’re traveling by car, try this: Run the air conditioner or heater, with the windows open, for at least 10 minutes. This will help reduce mold and dust mites in the car.

Your child’s triggers will determine what steps you need to take to prevent asthma flare-ups where you’re staying.

If pollen counts or pollution levels affect your child’s asthma and are high during your trip, travel with the win­dows closed and the air conditioner on.

Taking to the Sky
The air quality on planes may affect your child’s asthma. Although smoking on airplanes used to be commonplace, it is now banned on all commercial flights of U.S. airlines. Foreign airlines also must ban smoking on all flights into and from the United States. But smoking is not banned by law on charter flights, so if you’re taking one, ask about their smoking policy and request seats in the nonsmoking section.

The air on planes is also very dry,
so encourage your child to drink plenty of water while you’re in the air. Many airlines permit the use of battery-operated nebulizers (except during takeoff and landing), but check on this in advance. Nebulizers aren’t routinely included
in aircraft emergency kits due to their bulky size. But inhalers with spacers have been shown to be as effective
as nebulizers in treating asthma and might be easier to keep handy during travel.

Your Home Away from Home
Your child’s triggers will determine what steps you need to take to prevent asthma flare-ups where you’re staying. If pol­len or air pollution are triggers – and you’re traveling to a region with high readings – you may want to schedule a trip during times of the year when pol­len counts and smog levels are lower.

If dust mites or mold are a problem and you’ll be staying in a hotel, check to see if any rooms have been allergy proofed. Requesting a sunny, dry room away from the hotel’s pool might also help. If animal allergens are a trigger, request a room that has never had pets in it. And you should always stay in a nonsmoking room.

If you’ll be staying in a rented
cottage or cabin that’s near the beach
or in a forest, ask that it be thoroughly aired out before you arrive. Make sure any friends or family you’ll be staying with know about your child’s asthma triggers before you arrive. Although they won’t be able to clear away all dust mites or mold, they can dust and vacuum carefully, especially in the room where your child will sleep.

If scented candles, potpourri, aerosol products, or wood fires bother your child,
ask your hosts to avoid using them. You should also ask that no one smoke inside while your child is there.

Because it can take months for ani­mal dander to be effectively removed from a room, even if a pet isn’t allowed in it, you probably won’t want to stay with friends or family who have a pet if animal dander is a trigger for your child.

Wherever you’ll be staying, consider bringing your child’s pillow and blan­ket from home to ensure there’s some hypoallergenic bedding.

Time zone changes can be tricky. When traveling, try to have your child take medications at the usual home time. Upon arrival in another time zone, re­member to adjust the dosage times to the local clock.

Activity Smarts
If your child’s
asthma is well controlled, you should be able to enjoy sightseeing, hiking,
or other leisure activities. Just keep the asthma triggers in mind when planning what you’ll do. For example, avoid lots of walking or hiking when the air pol­lution or pollen counts are likely to be high or if the weather is going to be extremely cold and dry. If you’ll be camping, keep your child away from campfires.

Ski vacations or hiking trips aren’t out of the question. But make sure you plan for plenty of rest (indoors if possible), carry your child’s rescue medication at all times, and be prepared to change your plans if your child is struggling with asthma symptoms.

As at home, if anyone else will be supervising your child, you should make sure that person knows about the asthma and is familiar with your child’s asthma action plan.

Solo Adventures
If your child will be traveling alone (going to sleepover camp or staying with friends or family, etc.), make sure to advise any adults caring for him or her. It’s extremely important that counselors or chaperones be familiar with and have copies of the asthma action plan, list of medications, and emergency phone numbers. Also send written (and notarized) permission for the counselor or chaperone to care for your child in an emergency.

Sit down with your child before
the trip to go over the asthma action plan and what to do in an emergency. Your child should be familiar with any asthma triggers, should know how to administer medication, and should be able to recognize the signs of a flare-up.

Explaining that you’ve let the adults in charge know what to do during a flare-up should also help relieve any nervousness your child feels. And of course, offer reassurance that he or she isn’t different from other kids because of the asthma and should be able to
join in on all the fun.

If your child hasn’t been taking
controller medications and is relying on rescue medication to control the asthma, it might not be wise to allow
a solo trip, especially for an extended period of time. You’ll want to discuss this with your child’s doctor.

Most of all, be sure that your
child still takes all medications as
prescribed and tries to avoid triggers. Ignoring asthma during a trip could send your child to the emergency
department – and that’s no place to spend a vacation.

Hooray! Spring Is Here

… but So Is Hay Fever

Spring is in the air, and so are bil­lions of tiny pollens that trigger allergy symptoms in millions of people. This condition is called seasonal allergic rhinitis, commonly referred to as hay fever.

What’s the Problem with Pollen?
Hay fever is caused by pollen carried
in the air, which starts a chain reaction in your immune system. Your immune system controls how your body defends itself. For instance, if you have an
allergy to pollen, the immune system identifies pollen as an invader, or aller­gen. Your immune system overreacts by producing antibodies called immuno-globulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction.
Hay fever can affect your quality of life. It can lead to sinus infections, dis­rupt your sleep, and affect your ability to learn at school or be productive at work. Hay fever symptoms include:

Itchiness in your nose, throat, eyes, and ears, and on the roof of your mouth

Grass releases its pollen in the sum­mer. Timothy, Johnson, and Rye grasses are examples of allergens in this category.

Weeds cause hay fever in the fall. Ragweed is the biggest offender, as it can grow in nearly every environment.

Take Control of Your Symptoms
Hay fever cannot be diagnosed by
history alone. An allergist or immu­nologist can diagnose your allergies, and determine the specific triggers
that cause them, through simple tests. Once your allergy triggers have been identified, avoiding those triggers is
the best way to reduce your hay fever symptoms. Here are a few simple steps you can take to limit your exposure
to pollen:

Limit outdoor activities during days with high pollen counts.

Keep windows closed (at home and in the car) to keep pollen out.

Take a shower after coming indoors for the day. Otherwise, pollen in your hair may bother you all night.

In addition to avoiding your trig­gers, your doctor may recommend medications for temporary relief. Hay fever medications work best if started before allergy symptoms develop. If you start taking allergy medication
before you first come into contact with spring allergens, the medication can prevent the release of histamine and other chemicals. As a result, allergy symptoms are prevented from devel­oping or are much less severe.

Allergy shots (immunotherapy) have been proven to provide long-term relief of hay fever symptoms. Ask your doc­tor if immunotherapy is something you should consider.

Keep Your Hay Fever Symptoms in Check
with Accurate Pollen Counts

Pollen counts are measured with an instrument that is usually situated on a rooftop where it collects spores for a 24-hour period. The instrument is then taken to a lab where the
collected material is analyzed for pollen types and concentration.
Pollen counts are reported for spe­cific plants, such as trees, grasses, and weeds, and mold spores. Pollen counts are different from pollen forecasts, which are predicted based on the previous year’s pollen counts and current weather conditions.

To control hay fever symptoms, it is important to monitor pollen counts so you can limit your exposure on days the counts are
high. You can keep track of pollen counts in your area by visiting the National Allergy Bureau’s website, aaaai.org/nab.

Go with the Flow

Using a peak flow meter can help you keep your asthma in check. Here’s how.

Monitoring your asthma on a reg­ular basis is an important part of keeping your asthma under control. Keeping track of your symptoms whenever you have them is a good idea. This will help you and your doctor
adjust your treatment over time.

Another way to monitor your asthma is with a peak flow meter. This hand-held device shows how well air moves out of your lungs. Measuring your peak flow can help you tell how well your asthma is controlled. It can also alert you to an oncoming asthma attack hours or even days before you feel symptoms. During an attack, it can help tell you how bad the attack is and if your medi­cine is working. The peak flow meter also can help you and your doctor
learn what makes your asthma worse, decide if your treatment plan is work­ing well, determine when to add or
stop medicine, and decide when to
seek emergency care.

It’s a good idea to ask your doctor, pharmacist, or other healthcare profes­sional to show you how to use your peak flow meter. (See sidebar How to Use Your Peak Flow Meter.) The first step is to find your personal best peak flow number; then you can use the peak flow meter to keep an eye on how well your asthma is under control on a daily basis.

How to Use Your Peak Flow Meter

1. Always stand up. Remove any food
or gum from your mouth. 2. Make sure the marker on the peak flow meter is at the bottom of the scale. 3. Breathe in slowly and deeply. Hold that breath. 4. Place mouthpiece on your tongue and close your lips around it to form a tight seal. (Do not put your tongue in
the hole.) 5. Blow out as hard and fast as possible. 6. Write down the number next to the marker. (If you cough or make a mistake, don’t write down that number. Do it
over again.) 7. Repeat steps 3 through 6 two
more times. 8. Record the highest of these numbers in a notebook, calendar, or asthma diary.

Find Your Personal Best Peak Flow Number
Your personal best peak flow number is the highest peak flow number you can achieve over a two-week period when your asthma is under good control; that is, when you feel good and have no symptoms. To find your personal best peak flow number, take your peak flow readings at least twice a day (when you wake up and in late afternoon or early evening) for two to three weeks, 15 to 20 minutes after you take your quick-relief medicine, and any other time your doctor suggests.

Write down the number you get for each peak flow reading. Your doctor will use these numbers to determine your personal best peak flow and create three personalized peak flow zones. These zones are usually set up on your asthma action plan like a traffic light
– in green, yellow, and red. Mark the zones on your peak flow meter with colored tape or a marker. What your doctor tells you to do in each zone will help you know what to do when your peak flow number changes.

Use Your Peak Flow Meter to
Monitor Your Asthma
Every morning when you wake up, before taking your asthma medicine, take your peak flow. Make this part of your daily routine. Check this number against the peak flow zones on your written asthma action plan. Use the zone that your peak flow is in to help you make treatment decisions.

You should also use your peak
flow meter when you’re having asthma symptoms or an attack. First, take your medicine for the attack. Then take your peak flow. This will help you see if the medicine is working for you or if you need more treatment.

Know Your Peak Flow Zones

Green zone (Go) – 80 to 100 percent of your personal best – signals good control and no asthma
symptoms. If you take daily long-term control medicines, keep taking them. (And keep taking them
even when you’re in the yellow or red zones.)

Exercise-Induced Asthma Can Leave You Breathless

Learn how to manage symptoms while keeping active.

Many people confuse being out of shape with having exercise-induced asthma. Because the symptoms of exercise-induced asthma are similar to poor fitness (shortness of breath and a tight feeling in the chest),
it can be difficult to tell the difference between them. The symptoms of exercise-induced asthma may deter people from exercise. However, exercise-induced asthma can be controlled, and you can stay active.

What is exercise-induced asthma?
In asthma, the small airways of the lungs become irritated from various causes and begin to constrict. The bronchial muscles around the tubes go into spasm, and mucus builds up in the tubes. The cells that line the airways also start to swell, closing the airways even more. In exercise-induced asthma, this reac­tion is triggered by exercise. Although people with chronic asthma are more likely to have exercise-induced asthma, the presence of exercise-induced asthma does not lead to chronic asthma.

What causes exercise-induced asthma? The exact cause of what trig­gers an exercise-induced asthma attack is unknown. One theory is that symptoms may be triggered by drying or cooling of the airways during heavy breathing.

During normal breathing, the airway warms and moistens incoming air, which is usually cooler and drier. In the pro­cess, the airways can sometimes cool down and dry out, which can irritate sensitive tissues. During exercise, the amount of air moved in and out of the lungs increases, which also increases the amount of cooling and drying.

What are the symptoms of exercise-induced asthma?
The symptoms of exercise-induced asthma include:

Shortness of breath during or after
exercise

Tightness or pain in the chest

Coughing

Wheezing

The symptoms generally start a few minutes into exercise and may last for 30 to 60 minutes. In contrast, if the problem is poor fitness, the symptoms will usually disappear a few minutes after stopping exercise.

The symptoms generally start a few minutes into
exercise and may last for 30 to 60 minutes.

What should I do if I think I may have exercise-induced asthma?
Speak with your doctor if you believe you are experiencing exercise-induced asthma. An exercise challenge test can be used to determine whether you have exercise-induced asthma. Many doctors will base their diagnosis on your history and symp­toms. Your doctor also may have you do a trial of bronchodilator therapy prior to exercise. Although chest pain is a symp­tom of exercise-induced asthma, it is important for your doctor to rule out cardiovascular disease.

Additional Workout Strategies

There’s an exercise-induced asthma loophole called the refractory period. This period lasts up to two hours after an exercise-induced asthma attack. During this time, your lungs are less likely to react as strongly. If you warm up 45 minutes to an hour before your workout, you may be able to exercise without too many symptoms. Some athletes have found they can exercise easier by alternat­ing work and rest periods, also called interval training.

How can I prevent an exercise-induced asthma attack?
For starters, breathe through your nose. This will help warm and moisten the air before
it reaches the bronchial tubes. Stay
out of cold, dry air. If you do exercise outdoors, wear a facemask or scarf
to help warm the inhaled air with heat and moisture from your skin. If pos­sible, exercise indoors. You are less likely to have an exercise-induced
asthma episode when doing so. Opt
for lower-intensity sports, such as
golf, baseball, and weightlifting.

No matter what your activity, if
high amounts of airborne irritants (such as pollen) increase your chance of an
attack, it makes good sense to exercise indoors on days when those irritants are high. Most importantly, don’t stop ex­ercising. Exercise training will improve fitness so that a lower level of breath­ing is needed at a given exercise level. Good cardiovascular fitness will enable you to exercise at a higher intensity be­fore experiencing an exercise-induced asthma attack.

Does exercise-induced asthma
require medication?
In some cases, medicine is needed to treat exercise-induced asthma. There are two broad types of medications that your physi­cian might prescribe: bronchodilators and anti-inflammatory medication. Bronchodilators work to keep the
airways relaxed and open. They are used before or during exercise. Anti-inflammatory medications include inhaled corticosteroids, which reduce the sensitivity to the airways.

No one medicine works best for
everyone, and you may need a combi­nation for best control. If you are an elite athlete, it is important to check that the medication suggested for you is approved for use in your sport.

Sinus Headache vs. Migrane

Which One is Causing Your Pain?

Headaches. About 70 to 80 per­cent of us get them, with half the North American population experiencing at least one headache per month. While the majority of head­aches are not a sign of a serious or life-threatening illness, they can affect your quality of life.

Allergies and sinus problems can sometimes lead to a person having headaches. Headaches with rhinitis,
or hay fever, may be due to sinus dis­ease in and around the nasal passages. However, headache specialists consider true sinus headache to be rare. Recent studies have shown that many people who appear to have sinus headaches actually are experiencing migraines.

Types of Sinusitis
Acute sinusitis occurs when there is a bacterial infec­tion in one or more of the sinuses in your head. Sinusitis is often over-diagnosed as a cause of headaches
because of the belief that pain over
the sinuses must be related to the
sinuses. In reality, pain in the front
of the head is more often caused by migraines. Migraines are confused with true sinus headaches because of their similar locations.

Headaches attributed to acute bacterial rhinosinusitis are a specific, rare diagnosis. Antibiotics are often used for treatment. Other options include steam, corticosteroids, and deconges­tants. If sinusitis does not respond to medical treatment, surgery may need
to be considered.

Allergies and sinus problems
can sometimes lead to a person having headaches.

Chronic rhinosinusitis is one of the most common problems experienced with allergic rhinitis. People with chronic rhinosinusitis may also describe experi­encing “sinus headaches.” However, the jury is still out on whether constant blockage of the nasal passages caused by allergic inflammation can lead to chronic headaches.

People who experience blocked
nasal passages should visit an allergist for testing. An allergist can find out what you are allergic to and help you manage your symptoms. Treatment strategies could include avoiding spe­cific allergens, taking medications, and undergoing allergy immunotherapy,
or allergy shots.

Sinus Headache vs. Migraine
If you have headaches that seem like they’re originating in the sinuses, you should visit your doctor for a thorough evaluation to determine whether you are experiencing sinus headache or migraine. Making the right diagnosis is important because primary headache disorders, like migraines, and rhinosinusitis re­quire very different treatment regimens.

Doctors use the following criteria
to diagnose rhinosinusitis headaches:

A headache in the front of your head with pain in one or more areas of the face, ears, or teeth and clinical or laboratory evidence of rhinosinusitis; for example, your doctor might do a nasal endoscopy, which lets him or her see what is happening in your nasal and sinus passages

Headache and rhinosinusitis symp­toms that occur at the same time

Headache or facial pain that goes away within seven days after decreased symptoms or successful treatment of rhinosinusitis

The majority of people with self-diagnosed sinus headaches are really experiencing migraines, which is why it is important to see a doctor to get
a correct diagnosis. Research also
supports a link between migraine and allergy, so your physician will consider both migraine headache and sinus headache if you are experiencing
headaches along with allergic rhinitis.

All About the Itch

What You Should Know about Atopic Dermatitis

by Gil Yosipovitch, MD, and Shawn Kwatra, MD

Atopic dermatitis, also known as eczema, is a chronic skin disorder affecting hundreds of millions of people around the world. It has been estimated that 10 percent of the population will be affected by atopic dermatitis at some point in their lives. Atopic dermatitis often follows a waxing and waning course, filled with periods of disease flares and periods of remission. While atopic dermatitis may persist to adulthood, infants and young children are most frequently affected. The hallmark of atopic dermatitis is the terrible itch it causes.

What Causes Atopic Dermatitis?
Since
Researchers do not know the precise cause of atopic dermatitis, but evidence points to an involvement of both heredi­tary and environmental factors. Atopic dermatitis is part of an allergic triad of conditions that also includes asthma and hay fever (seasonal allergies). These conditions are thought to be caused
by an inherited predisposition to an overactive immune system. Indeed, substances called cytokines, which
are secreted by cells in the immune system, are often more numerous in people who have atopic dermatitis.

Atopic dermatitis
features a vicious
itch-scratch cycle.
The itch causes
you to scratch,
and scratching
worsens the itch.

Researchers recently found that people with atopic dermatitis have a genetic defect in filaggrin , a protein that plays a significant role in forming the upper layer of the epidermis, also known as the stratum corneum. With­out sufficient filaggrin, the skin barrier is weakened and becomes accessible and sensitive to germs, allergens, and many other foreign substances. Since a weakened skin barrier increases nerve fibers’ exposure to the environment, people who have atopic dermatitis
are more likely to be irritated by exposure to soaps, detergents, and even temperature changes. Because the skin is missing some of its natural building blocks, many people who have atopic dermatitis experience the symptoms of dry skin. This is why people who have atopic dermatitis benefit so much from using moisturizers containing ceramides, substances that are vital to the barrier of the skin because of their ability to replenish it.

Dr. Shawn Kwatra(Photo by Scott Faber Photography)

Skin Manifestations
Since
Atopic dermatitis causes significant inflammation and severe itch and scratching, which in combination lead to skin redness and crusting, scaling, and often oozing skin lesions. These lesions often affect the skin folds of the arms and back of the knees and below the ears. People from different ethnic groups often have different presentations of atopic dermatitis.

Itch
Since
Itch is the primary symptom
of people who have atopic dermatitis. Severe and frequent or constant itch leads to many sleepless nights and
severely impairs a person’s quality of life. Itch in atopic dermatitis is aggra­vated by proteases, small proteins that are also secreted by Staphylococcus aureus (a bacterium that is found in the respiratory tract and on the skin) and house dust mites, common triggers of atopic dermatitis flares. Scratching is hard to resist and may lead to thickened and darkened areas of skin, bacterial infections, and worsening rashes. Atopic dermatitis features a vicious itch-scratch cycle. The itch causes you to scratch, and scratching worsens the itch. This cycle keeps repeating itself, leading
to damage to the skin barrier as well
as breaks in the skin that can lead
to infections.

Many people who have atopic der­matitis are not aware of how much they are scratching, particularly during the night, which not only disturbs sleep but further increases skin inflammation.

In addition to interrupting restful sleep, itch in atopic dermatitis can be
a contributing factor to psychosocial conditions, including depression, anxi­ety, difficulty concentrating, and poor self-esteem. Similarly, stress is known to be an aggravating factor for itch in people who have atopic dermatitis. Building on this association, a study using brain imaging found that itch
in people who have atopic dermatitis significantly differs from itch induced in healthy individuals; that is, itch in people who have atopic dermatitis
activated areas of the brain involved
in emotion and in the memory of nega­tive experiences. This study highlights the role of cognitive and emotional
factors in the exacerbation of itch in atopic dermatitis.
Factors aggravating itch in people who have atopic dermatitis can be broadly categorized as follows: environmental
triggers, allergens, emotional stress, and infections.

Treatment of Itch
Since
The treatment of itch is specialized based on the
age and circumstances of the person being treated. However, treatment should focus on two fronts: 1) instiuting measures for prevention of atopic dermatitis-associated itch and 2) providing symptomatic relief
for itch associated with current
skin lesions.

Preventing Itch
Since
People who have atopic dermatitis often have a dis­rupted skin barrier. For this reason,
it is important to moisturize the skin as soon as possible after bathing, to replenish the skin barrier and prevent water loss and irritation. (Be sure to select a moisturizer that replenishes ceramide and other lipids that are depleted in the outer layers of the skin in people with atopic dermatitis.)

Indeed, a study found that the amount of water loss in the skin is associated with the intensity of itch. Use low pH cleansers, which are
effective at reducing itch because their low pH reduces the activation
of nerve fibers that are often overly sensitive to enzymes activated by higher pH cleansers. In addition,
you and your family should try to keep a diary documenting the cir­cumstances surrounding episodes
of severe itch and use the diary
to try to identify an association
between itch or increased itch and specific factors.

Relieving Symptoms
Since
atopic dermatitis features a hyperactive immune response, drugs
that can suppress the immune
system (either applied directly
to the skin or taken orally) are
effective in relieving symptoms
of itch associated with atopic
dermatitis.

Dr. Gil Yosipovitch is a professor and chair of the department of Dermatology and director of the Temple Itch Center
at Temple University School of Medicine in Philadelphia, PA. Dr. Shawn Kwatra
is a resident in the department of Derma­tology at The Johns Hopkins School of Medicine in Baltimore, MD.

Six Ways You Might Unknowingly Make Your Guests Sick this Holiday Season

The holiday season can gift you with more than you’ve wished for if you have allergies and asthma. Holiday traditions, such as Christmas trees, menorahs, and poinsettia plants, can cause symptoms. Those hosting holiday gatherings can also unknowingly present guests with the gift of sneeze.

“Allergy and asthma sufferers are bound to come across triggers this holi­day season,” says allergist Michael Foggs, MD, president of the American College of Allergy, Asthma & Immunology. “By ensuring your home isn’t allergen laden, you can help guests relax, feel great, and have an enjoyable season.”

Here are six tips to help you have the least amount of allergens in your home when you invite guests over during the holiday season.

1Meet Fido, Dusty, and Mold
Dan­der, saliva, and urine from animals can trigger allergic reactions and asthma attacks in guests. It’s best to clean your home thoroughly before guests arrive, ban pets from upholstered furniture, and keep your pets in another room while visitors are present. Don’t forget about the other “pets” that might be in your home, including dust and mold spores. Vacuuming and cleaning hard surfaces can help remove dust mites, and replacing your air filter will help with both dust and dander. Be sure to also clean any visible mold from the bathroom and kitchen, as well as from the rubber seal on your refrigerator.

2Your Home Smells (Achoo!) Lovely
Candles and plug-in air fresheners may seem like a great way to freshen up your home, but they can be harmful. About one-third of people with asthma report health problems related to air fresheners, which contain volatile
organic compounds (VOCs). Store the candles, and let the scents from the oven provide natural aromas.

About
one-third
of people
with asthma
report health
problems
related to
air fresheners.

3Cheers to an Allergic Reaction
Breaking out the bubbly might seem like a great way to toast the holi­days. That is until one of your guests has an upset stomach, trouble breathing, and itchy eyes. Reactions to alcohol can be triggered by naturally occurring ingredients in beer and wine, including barley, ethanol, grapes, histamine, hops, malt, oats, tryptamine, tyramine, wheat, and yeast. Try toasting with a holiday-inspired punch or sparkling juice instead.

4Spice Isn’t Always So Nice
Spices may be a key ingredient in nearly every holiday dish, but they may also cause your guests to sneeze and wheeze. Spice allergy is responsible for an
estimated 2 percent of food allergies. Common spice allergy triggers include cinnamon and garlic, but anything from black pepper to vanilla can cause a re­action. Before you prepare your meal, check with guests about any food
allergies they might have, including sensitivities to spice.

5Share Cheer, Not Viruses
The
flu season coincides with the holi­day season, lasting from October to March. Protect yourself from giving and receiving the virus by getting a
flu shot and washing your hands regu­larly. Have an egg allergy? Allergists still recommend getting the flu shot because the vaccinations contain such
a low amount of egg protein that it likely won’t cause an allergic reaction. Play it safe and have your allergist
administer the shot and monitor you
for 30 minutes to ensure there is
no reaction.

6Don’t Be a Chatty Cathy
Save
long conversations for once you see your guests in person. Cell phones, including smartphones and flip models, can contain allergy-causing cobalt and nickel. These metals can cause redness, swelling, itching, eczema, blistering, skin lesions, and occasional scarring. For allergy fighters who are glued to their phones, allergists advise opting for plastic phone cases, wireless
earpieces, and clear film screens to
decrease allergic reactions.

Get Ready for Indoor Winter Living with Asthma

Watch Out for These Common Asthma Triggers

Triggers are a part of everyday life. Asthma attacks can be
triggered by things like mold growing in your bathroom or tiny dust mites that live in blankets, pillows, or your child’s stuffed animals. Here’s a breakdown of common asthma triggers and what you can do to get rid of them.

Mold
This icky asthma trigger grows on damp things such as shower curtains, bath items, tubs, basins, and tiles. If you see mold, clean it up with soap and wa­ter. To prevent mold growth, you need to control the moisture in your home. Use exhaust fans in the bathroom when showering and in the kitchen when cooking or washing dishes. Fix leaky plumbing or other sources of water
as soon as possible. Dry damp or wet items within one to two days to keep mold from growing.

Dust Mites
These are tiny bugs you can’t see with the naked eye. They live in sheets, blankets, pillows, mattresses, soft furniture, carpets, and stuffed toys. To rid your home of these pesky asthma triggers, wash bed sheets and blankets once a week. Use dust-proof covers on pillows and mattresses. Vacuum carpets, rugs, and furniture often. And wash stuffed toys regularly.

Secondhand Smoke
Asthma can be triggered by the smoke from the burning end of a cigarette, pipe, or
cigar, or the smoke breathed out by
a smoker. Steer clear of secondhand smoke whenever possible. Choose
not to smoke in your home or car,
and don’t allow others to do so either.

The chemical
irritants found in
some products
in your home may
make asthma
worse.

Wood Smoke
Smoke from wood-burning stoves and fireplaces contains a mixture of harmful gases and small particles. Breathing in these small
particles can cause asthma attacks and severe bronchitis, aggravate heart and lung disease, and increase the likelihood of respiratory illnesses. To help reduce smoke, make sure to burn dry wood that has been split, stacked, covered, and stored for at least six months. Never burn garbage, plastics, or pressure-treated wood. Have your stove and chimney inspected every year by a certified pro­fessional to make sure there are no gaps, cracks, or unwanted drafts, and to re­move dangerous creosote build-up. If possible, replace your old wood stove with a new, cleaner heating appliance. Consider using a HEPA filter in the same room as your stove or fireplace. Studies indicate that HEPA filters can reduce indoor particle pollution by 60 percent.

Cockroaches and Other Pests
Asthma attacks can be triggered by cockroaches and other pests, such as mice. To keep these pests out of your home, make sure your counters, sinks, tables, and floors are always kept clean. Wash dishes and clean up crumbs and spills immediately. Store food in air-tight containers, and keep your trash cans covered.

Cats and Dogs
Warm-blooded ani­mals may trigger asthma attacks. Keep pets outside if possible. If you do have pets inside, keep them out of the
bedroom and off the furniture. Vacuum carpets and furniture often to reduce the amount of pet dander (small flakes of shed skin) in your home.

Nitrogen Dioxide
This is an odor­less gas that can irritate your eyes, nose, and throat and may cause shortness of breath. This gas can come from using appliances that burn fuels (such as gas) and kerosene. If possible, use fuel-burning appliances that are vented outside, and always follow the manu­facturer’s instructions on how to use these appliances. Never use gas stoves to keep you warm or heat your home. If you have an exhaust fan, use it when you cook. If you have an unvented ker­osene or gas space heater, use the proper fuel and make sure the heater is adjusted correctly. Open a window slightly or turn on an exhaust fan when using these types of heaters.

Chemical Irritants
The chemical irritants found in some products in your home, such as cleaners, paints, adhesives, pesticides, cosmetics, and air freshen­ers, may make asthma worse. If certain products irritate your or your child’s asthma, use these products less often and make sure the asthmatic person is not around when you do use them. You may also consider trying alternative non-irritating products. If you must use these products, try to make sure that windows or doors are open and that you use an exhaust fan. In addition, take great care to follow the instructions on the label.

If you or your child has asthma, or if you think your child may have asthma, make an appoint­ment with a doctor. Your doctor will work with
you to create an asthma action plan that will
help you learn to prevent asthma attacks.

Managing Asthma during Pregnancy

Do You Know What Makes Your Asthma Worse ?

Most women with asthma do very well during pregnancy. There is good evidence that having asthma does not increase your chances of having a baby with birth defects or of having multiple births. Furthermore, studies show that asthma can be controlled with medication dur­ing pregnancy with little or no risk to you or your baby. Together, you and your doctor will determine the best ways to safely manage your asthma, including weighing the benefits of all medication you take versus the risks
of those medications to both you and your unborn baby.

During pregnancy, it is important
to know what things may make your asthma worse and how to avoid or cope with them. The following are things that may make your asthma worse, especially during pregnancy.

Irritants
Do not smoke cigarettes, and avoid exposure to second-hand smoke. Both can make asthma worse and pose major risks for your unborn baby.

Allergies
During pregnancy, make a special effort to avoid things you are allergic to. Pollen, mold, animal dander, house dust mites, and cockroaches are common allergens.

Exercise
Continuing to exercise while pregnant is desirable, but if exer­cise makes your asthma worse, talk with your doctor. Using inhaled medication before you exercise can often prevent asthma symptoms while you exercise.

Infections
A cold, the flu, or other respiratory infections can make asthma worse. Good hand washing is the most effective way to avoid the spread of common cold viruses. And the yearly flu vaccine is strongly recommended for people with asthma; it may be
given during the second or third trimester of pregnancy.

Sinusitis
This can make asthma worse, especially at night. Treating the inflammation in the nose and decreasing the post-nasal drip can reduce cough and throat irritation. Sinusitis is often treated with a nasal wash or a steroid nasal spray. It also may be treated with an antibiotic.

Emotions
Pregnancy can be an in­tensely emotional time. Emotions do not cause asthma, but if a person has asthma, strong emotions can make it worse.

Weather
Your asthma may worsen with changes in the weather, especially when they are sudden. You should be prepared to dress accordingly and avoid polluted or cold air. Work with your doctor on keeping your asthma under good control whatever climate you live in, whatever the season.

Gastrointestinal or Gastroesophageal Reflux Disease (GERD)
In some people, the muscle between the esophagus and stomach allows some backflow of stom­ach acid into the esophagus. This can cause heartburn and may also cause constriction of your bronchial tubes, resulting in asthma symptoms. This is more common during pregnancy, but
it is treatable.

Hormone Changes
You will experi­ence a variety of hormonal changes during pregnancy. These hormones
can affect both your emotions and your asthma. Your asthma may worsen, im­prove, or stay the same while you are pregnant. If you are among the one-third of pregnant women whose asthma worsens, you may need additional medication.

The Importance of an Asthma Action Plan

Early awareness of asthma symp­toms and peak flow monitoring can help you and your doctor respond quickly to worsening of your asthma during preg­nancy. It is important to identify and
treat your asthma when the symptoms are still mild to reduce the risk of a more serious episode. Common asthma symptoms may vary from person to
person and include the following:
♦ Cough
♦ Shortness of breath
♦ Tightness in the chest
♦ Wheeze

Many of these symptoms are
common during pregnancy, and it
sometimes may be difficult to tell if the cause is the increasing size of your
baby or your asthma. An asthma action plan is a written plan based on changes in asthma symptoms and peak flow numbers, customized to your needs
by your doctor, to help you manage asthma worsening. It will give you
information about when and how to
use long-term control medicine and quick-relief medicine. It is a reminder
of what to watch for and what steps
to take so you will be able to make
timely and appropriate decisions
about managing your asthma during your pregnancy.

Your Flu Questions Answered

If you have asthma, it’s especially important to protect yourself from the flu. Here’s how.

Though people with asthma are not more likely to get the flu, influenza can be more serious for people with asthma, even if their asthma is mild or their symptoms are well-controlled by medication. This is because people with asthma have swollen and sensitive air­ways, and influenza can cause further inflammation of the airways and lungs. Influenza infection in the lungs can trigger asthma attacks and a worsening of asthma symptoms. It can also lead to pneumonia and other acute respiratory diseases. To help you prepare for the upcoming flu season, here are answers to some important flu-related questions.

Should I get a flu shot?
People with asthma are at increased risk of severe disease and complications from the flu, so everyone with asthma who is six months old and older should get a flu vaccine. Vaccination is the first and most important step in protecting against influenza. Even if you don’t have a regular doctor or nurse, you can still get the flu vaccine. Flu vaccines are offered in many locations, includ­ing doctors’ offices, clinics, health departments, pharmacies, college health centers, and increasingly by a number of employers and public schools.
People with asthma should get the
flu vaccine made with inactivated flu virus (commonly called a flu shot),
not the nasal spray vaccine. Addition­ally, adults and children with asthma are more likely to develop pneumonia after getting sick with the flu than people who do not have asthma, so you should also get the pneumococcal vaccine to protect against pneumonia. The pneu­mococcal vaccine may be given at the same time as the flu shot.

What can I do to help reduce the spread of the flu?
Stay home when you are sick, except
to get medical care, and stay away from other people who are sick. Cover your nose and mouth with a tissue when coughing or sneezing, and throw the tissue away after you use it. If you do not have a tissue, cough or sneeze into your elbow or shoulder, not your bare hands. Wash your hands often with soap and water, especially after cough­ing or sneezing. Avoid touching your eyes, nose, and mouth; germs are spread that way. Clean and disinfect frequently touched surfaces at home, work, and school, especially when someone is ill.

What should I do if I think
I may have the flu?
If you do get sick with flu symptoms, call your doctor, and take flu antiviral drugs if your doctor recommends them. Treatment should begin as soon as
possible because antiviral drug treat­ment works best when started early (within 48 hours after symptoms start). Antiviral drugs can make your flu ill­ness milder and make you feel better faster. They may also prevent serious health problems that can result from the flu. However, people with asthma should not use the antiviral drug zanamivir (Relenza) because there is a risk it may cause wheezing in people who already have asthma or other lung problems.

Former Supernanny Jo Frost Wants You to Be Prepared for Anaphylaxis

Jo Frost is
prepared with
her epinephrine auto-injectors.

Professional family expert Jo Frost has a passion for helping families in crisis across the globe, a task she tackles on TLC’s Family S.O.S. with Jo Frost. Recently, Jo teamed with Mylan Specialty L.P., the marketers and dis­tributors of EpiPen, on a campaign to help raise awareness for another cause she’s passionate about – anaphylaxis preparedness.

TV’s former Supernanny was just a toddler when a bite of shrimp sent her into anaphylaxis (a life-threatening
allergic reaction). That’s when her fam­ily learned she had severe allergies she would have to deal with for the rest of her life. In an interview with Coping® magazine, Jo (who is also allergic to nuts) explains how she stays vigilant about managing her food allergies, and how you can do the same.

How have your allergies affected
your life?
I’ve got to have my anaphylaxis action plan, which includes avoiding all trig­gers that could potentially be harmful for me. So with my work, as much as children love PB&J sandwiches, certain treats are off limits for the families and the crews when I’m filming. And they’re very, very aware of it. You have to communicate with those around you so they’re aware, so that your environment becomes a much safer one for you.

You have to be prepared. I always carry two EpiPens with me, so I’m
always prepared with my epinephrine auto-injectors. Then, if something does happen, I would administer one of those and seek emergency help straight away.

You have to dine out a lot when you travel for your show. What advice
do you have for dining out with food allergies?
When you have a life-threatening allergy, even if you have your action plan in place and you’re carrying your two EpiPens, you must learn to speak up and to be assertive. Speak to the wait staff. Ask them about the menu. Don’t assume that if you don’t see any particular aller­gens on the menu that they don’t exist. Ask what’s in the actual food. There have been many times when I’ve said, “I feel a little bit doubtful. Could I speak to the chef please? It would really ease my mind.” Most have been very accommo­dating. When you have a life-threatening allergy, you need to do what’s necessary to keep yourself safe.

How can parents encourage their food-allergic children to proactively manage their condition?
I think by making them more assertive, making them aware, and talking about scenarios and circumstances that could put them in danger and how to manage those situations. Help them learn how to manage everyday life so they don’t feel handicapped.

What message would you like to send others with life-threatening allergies?
The more we speak about it and the more we educate people, then the more they understand that this is something we live with every day. We are working and we are living life alongside our life-threatening allergies.

It certainly hasn’t stopped me. I’m doing the things that I want to do in my life, whether I’m climbing Camelback Mountain or flying across the pond trav­eling from one country to another. I go to parties without thinking, “Oh my God, what am I going to eat? What am I going to do?” I would love for adults who have life-threatening allergies and parents of children with life-threatening allergies to have that kind of attitude. Having an action plan in place really empowers you to live your life to
the fullest.

What else should people understand about serious allergies?
It affects all of us, whether we have life-threatening allergies or not. My partner doesn’t have any life-threatening allergies, but he certainly knows that if he goes out for Thai food, it has to be when I’m traveling away from home.
I have coworkers who know not to bring peanuts into the office. When people are more aware of serious allergies, even if they don’t have any, they can become more empathetic to those that do have them.

In celebration of the 25th anniversary of the EpiPen Auto-Injector and to emphasize the im­portance of being prepared for an anaphylactic reaction, Jo proclaims, “Show Us Your EpiPens!” Log on to 25YearsofEpiPen.com to learn more about anaphylaxis preparedness and to upload
a photo showing how you take your EpiPen with you everywhere you go. “Upload those photos, and look out for mine, as well,” Jo adds.

This article was originally published in Coping® with Allergies & Asthma magazine,
September/October
2013.

How Harmful Is the Air You Breathe?

Air impurities can be bad news
for people with asthma. Learn
how to protect yourself.

Clean air is an important health concern for all of us. But when you have asthma, air quality indoors and out can make all the differ­ence in the world. Car exhaust, smoke, road dust, and factory emissions can make outdoor air dangerous, while tobacco smoke, dust mites, molds, cock­roaches, pet dander, and household chemicals are just a few of the indoor hazards. Unhealthy air can create a dif­ficult barrier to asthma management.

An asthma trigger is anything that causes symptoms making it difficult to breathe. While an asthma trigger can be many things, from exercise to extreme temperatures to stress, some of the most common triggers are impurities in the air. Being aware of what’s in the air, and the things you can do to reduce your exposure to air impurities, is an important key to living an active and healthy life with asthma.

Protect Yourself Outdoors
People with asthma are particularly sensitive to the health risks of outdoor air pollution. Ozone pollution (smog) and particle pollution (soot), the most common air pollutants, are powerful asthma triggers, as are vehicle exhaust, wood smoke, and fumes.

Because outdoor air quality can be beyond your control, your best defense is knowledge. Knowing the current air quality outside can help you plan your day and make decisions about things like exercise, travel, and outdoor activities. You can’t always see or smell air pol­lution. The best way to stay informed before you leave your home is by check­ing the air quality forecast (AirNow.gov). That forecast uses a color-coded air quality index (AQI) that tells you how clean or polluted the air will be.

When the AQI is orange or higher, you should reduce or limit exercise or strenuous activities outdoors. Exercise indoors and save yard work for a day when the forecast is better. If you are unusually sensitive (for example, if you have severe asthma), you may want to reduce prolonged or heavy outdoor
exertion if the AQI is at yellow. If the air quality worsens to red or purple, it’s best to just stay inside.

Always avoid exercise near high-traffic areas. Areas within one-third of a mile of a busy highway likely have much more pollution even when the rest of the community has a green air quality forecast. Also, remember that children are at particular risk even if they don’t have asthma. They tend to be more active, breathe faster, and
expose their lungs to more pollutants.

Protect Yourself Indoors
Many people don’t know that the air indoors can be even more polluted and harmful than the air outside. Americans spend up to 90 percent of their time indoors. Indoor air can be filled with asthma triggers like cigarette smoke, dust mites, molds, cockroach allergen, pet dander, gases or fumes, household or industrial chemical irritants, and wood smoke.

The best way to protect your family at home is to avoid air pollution in the first place. Make sure no one smokes indoors. Clean surfaces in your home weekly with a damp cloth and a HEPA-filtered vacuum. Eliminate sources of moisture by fixing water leaks and
using exhaust fans when showering, cooking, and washing dishes. Keep humidity levels below 50 percent. Put away food, cover trash, and use baits
to control pests, like cockroaches. And don’t use scented candles or fragrances to cover up odors.

Ventilation is very important for keeping the air quality in your home
as clean as possible. Fresh air needs
to come indoors while dirty indoor air needs to go outside. Installing a central air-conditioning unit may be very ben­eficial to people living with asthma. It’s important to maintain your central air-conditioning unit to ensure that it’s bringing fresh air in and removing dirty air to the outdoors. For better ventilation in your home, you should also install and run exhaust fans in the kitchen and bathroom and vent fuel-burning appli­ances, such as gas stoves and heaters, to the outside. Use an exhaust fan or open a window slightly while these appliances are in use. Open windows and use extra exhaust fans when you’re working with paints or chemicals indoors.

By learning how to protect yourself from impurities in the air, you are an­other step closer to better asthma control.

If you have a smartphone, you can check the
AQI any time by downloading the American Lung Association’s free State of the Air app. This app gives you current local air quality information and helps you decide what actions to take. For more information on lung health, call the American Lung Association’s Lung HelpLine at (800) 586-4872 or visit lung.org.

5 Tips for Scaring Away Spooky Halloween Health Hazards

An unwanted cavity in your child’s sweet tooth isn’t the only health concern that can haunt the Halloween season. Hidden health hazards can be lurking not only in candy but also in costumes, haunted houses, and jack-o-lanterns, especially for little ghosts and goblins who have allergies and asthma. The following
is a list of common Halloween health hazards with tips on how to avoid them.

1 From Hair-Raising Screams to Frightening Wheeze
Haunted houses may be scary fun, but they can cause real-life fright if your child can’t breathe easily. Excitement and anxiety provoked by zombies, ghouls, and goblins can sometimes trigger asthma symptoms if your child’s
asthma isn’t properly controlled. Run­ning from house to house in search of treats can also trigger symptoms. If your child has asthma or exercise-induced bronchoconstriction (EIB), be sure he or she carries emergency medicine, such as a quick-relief inhaler, and uses it as prescribed to prevent symptoms.

2
Hidden Allergy Tricks in Halloween Treats
Halloween is a tricky time if your child has food allergies, especially to peanuts. But dairy, wheat, and eggs are also com­mon allergens found in different candies and other Halloween treats. Read prod­uct labels carefully before letting your child indulge in his or her sweets. Also, if you suspect your little one has a food allergy, make sure to see an allergist for testing to identify all of your child’s triggers far in advance of Halloween festivities. (See sidebar for more tricks for ensuring your child has allergy-safe treats.)

Simple Tricks for Ensuring Allergy-Safe Treats

Halloween candy is a big part of trick-or-treating fun. But for children with food allergies, these edible treats can mean trouble. Here are some simple tricks for ensuring your child has allergy-safe Halloween treats.

♦ Purchase treats that your child can enjoy safely, and swap them for treats with allergens after trick-or-treating. ♦ Send candy your child can consume to Halloween parties or send non-food goodies like spooky stickers.♦
Volunteer to provide the snacks for Halloween parties at school to ensure there will be foods available that your child can enjoy.♦
Always have emergency medications on hand just in case unrecognized food allergens are hiding in Halloween treats.

3
Petrifying Pumpkins
Jack-o-lanterns might be more than just a scary face if your child has an allergy to pumpkin. Although a pump­kin allergy is rare, it can develop at any time, suggests research from the Annals of Allergy, Asthma & Immunology. Anything from carving a pumpkin to munching on its seeds can cause an
allergic reaction with symptoms that can include chest tightness, hives, and vomiting.

4
Beware of Costumes
From the dusty clown costume that was retrieved from the attic to the mask made of latex to the nickel in jewelry, swords, and other accessories, Hallo-ween dress-up can be a landmine of allergy and asthma triggers. Dress your allergic child wisely. Some kids also have contact dermatitis that can be caused by the preservatives in Halloween makeup. If you’re not sure what triggers your child’s allergies, see an allergist who can help pinpoint the problem.

5
Menacing Mold
While jumping through piles of leaves can be tempting for your little ones as they are trick-or-treating, it can also be harmful. Molds are commonly found on leaves this time of year and can cause severe asthma attacks. Running through leaves can cause mold to stir into the air, resulting in high exposure. Plan ahead and talk with an allergist about seasonal allergy and asthma triggers and how they can be avoided.

Allergies and asthma are serious diseases that, when left untreated, can be dangerous. If you suspect your child has one of these conditions, make an appointment with a board-certified allergist to develop a treatment plan that may
go beyond over-the-counter medications. For more information and to find an allergist, visit AllergyandAsthmaRelief.org.

Don’t Let Ragweed Ruin Your Fall Fun

Pollen from trees, grasses, and weeds floats around in the air where it can be inhaled, causing allergy and asthma symptoms for many people. Pollen may travel many miles in the wind, so even trees, grasses, and weeds beyond your immediate area
can be the cause of your sneezing and wheezing. Pollen allergies are often seasonal, and allergy and asthma symp­toms occur when the amount of pollen in the air is high.

A grim sign for some allergy and asthma fighters appears as the summer begins to wind down: ragweed and sage­brush pollens begin to show up for the first time in daily pollen counts. Those pollens are potent allergens for many people, causing them to experience the itchy eyes, runny nose, and sneezes of seasonal allergies, or hay fever, as well as causing their asthma to become worse.

If you’re allergic to ragweed and sagebrush pollens, you can expect your allergies and asthma to flare up during the months of August and September and possibly longer in different parts
of the country. Ragweed and sagebrush pollen levels often persist until the first frost or beyond. It is difficult to predict how bad ragweed allergy season will be or how long it will last.

Ragweed season can make allergy and asthma fighters miserable if they don’t take precautions. Here are some simple measures that can significantly reduce your allergy and asthma symptoms.

Start taking your medications early.
Allergy medications work best if you take them before your immune system has revved up enough to initiate irritating allergy symptoms. Once the immune system is in high gear, medications are less effective and take longer to relieve those symptoms.

It may help to
limit your outdoor activities during the times of highest
pollen and mold counts.

Keep outside air out.
The key to eliminating or reducing exposure to pollen is to keep outside air out, or filter it before it comes inside. The normal filters on an air conditioning unit are quite adequate for this. Using swamp coolers is discouraged because of the increased potential for dust mite and mold growth, two common allergens that thrive in humidity.

Consider pollen counts when
planning outdoor activities.
It may help to limit your outdoor activities during the times of highest pollen and mold counts. Weed pollens are at their highest levels around midday. Do your gardening and other outdoor activities in the early morning, if possible. Outdoor activities also may be better tolerated after a gentle, sustained rain.
If you are outdoors during high
pollen counts, take a shower and wash your hair when you come inside. Change your clothes (not in your bedroom) when you come indoors, and leave these clothes in the laundry room. Dry your laundry in a clothes dryer only; avoid hanging clothes outside to dry, where they can collect pollen.

Close your windows, even at night.
Although weed pollens may peak
during midday, enough weed pollens continue floating in the air during the night to plague people with allergies.
If you need some cool air, turn on the air conditioning instead of opening your windows. You should drive with your windows closed as well. If it is hot, use your air conditioner.

Wash your hands frequently.
You can easily pick pollen up on your hands by touching door handles, running your hands through your hair after you’ve been outside, or touching other outdoor surfaces. If you rub your eyes or nose with those pollen-covered hands, you can launch a full-blown allergy attack. Washing your hands reduces the chances that you will get pollen in your eyes
or nose.

Beware of melons and bananas.
People who are allergic to ragweed may feel a tingling or burning in their mouths after eating cantaloupe, honey­dew melon, watermelon, or bananas. These fruits may cause these symptoms year-round but are even more likely to do so during ragweed season.

Keep pets that spend time outdoors out of the bedroom.
In addition to ani­mal dander allergens, they may carry and deposit pollen stuck to their fur.

Beat the Heat!

Before jumping in the deep end, make sure
the pool area is well ventilated and doesn’t have a strong chlorine or chemical odor.

High humidity mixed with high temperatures and air pollution can make breathing difficult for everyone, espe­cially for people with asthma. Here are some easy-to-follow tips on how to protect your lungs during the dog days of summer.

Get a heads up before you head out.
The Air Quality Index is an index for reporting daily air quality. It tells you how clean or polluted your air
is, and what associated health effects might be a concern for you. Air quality rankings are divided into six levels – from healthy to hazardous. To check out your local air quality and receive automatic air quality alerts, you can download the American Lung Asso­ciation’s State of the Air app, available at lung.org and in Android and iPhone markets, or visit AirNow.gov.

Pack a bag and be prepared.
Deal­ing with rising temperatures is a little easier if you take a few minutes to
prepare. Pack a bag with everything you need to manage asthma symptoms in case they crop up while you’re out. Your quick-relief inhaler should be with you at all times; you never know when you might need it. You should also
carry your spacer or valved holding chamber. Use it with your quick-relief inhaler as directed by your doctor.

Your bag should also include a copy of your asthma action plan. Follow the instructions laid out in your plan as soon as you begin to feel asthma symptoms. Your peak flow meter, if prescribed
by your doctor, is also good to have
on hand. You may have a drop in your peak flow reading before you even
begin to feel symptoms. If you do,
follow the instructions in your asthma action plan. And make sure to always bring along plenty of water to drink
so you can stay hydrated.

Get ready to go.
Using your quick-relief inhaler 15 to 30 minutes before going outside in the heat or exercising will help you avoid asthma symptoms. But asthma medicines only work if you use them the right way. Talk to your doctor about when and how to use your asthma medications.

Take it easy.
On really hot days, even regular activity can feel strenuous and cause asthma symptoms. If possible, schedule outdoor activities in the early morning or late evening. Stay inside where it’s cool as much as possible. When at home or in the car, keep win­dows closed and the air conditioning on. Air-conditioned places like museums, libraries, and movie theaters are cool hangouts for family and friends during the heat of the day.

Splash around.
Splashing around the water park and swimming not only will keep you cool but it also can be great exercise. However, chlorine and other chemicals found in indoor and outdoor pools and water slides can be an asthma trigger. Before jumping in the deep end, make sure the pool area is well ventilated and doesn’t have a strong chlorine or chemical odor. If
you can smell the chemicals, you should probably leave.

Go fragrance-free.
Sunscreens,
tanning lotion, bug spray, and citronella candles all have fragrances that can worsen asthma symptoms. Choose products that are unscented, and opt
for lotions instead of aerosol sprays. You can avoid mosquito breeding grounds by emptying containers with standing water and changing the water in birdbaths every few days.

This article was originally published in Coping® with Allergies & Asthma magazine,
Spring/Summer
2013.

Living with Food Allergies

Answers to Questions You May Not Have Thought to Ask

by Scott H. Sicherer, MD

If you have
a fish allergy,
it is possible to enjoy fishing by taking a few
precautions.

How much food needs to be eaten
to trigger a reaction?
The amount of food that can trigger
a reaction depends on an individual’s sensitivity. It is not easily predicted by any simple tests. For some people, trace amounts that are not easily visible to the naked eye may cause symptoms, and for others, a meal-size amount of a food or more may be required to trigger a reac­tion. Your doctor may be able to assess your level of sensitivity based on your history or your response to a feeding test.

Can smelling a food cause an
allergic reaction?
Yes, but this type of exposure is
unlikely to cause anaphylaxis.

When can smelling a food cause an
allergic reaction?
When the protein from the food is
distributed into the air.

Under what circumstances would food proteins become airborne?
This most often occurs from heating, such as in cooking. For example, the steam from scrambling eggs or frying fish and the vapor from boiling or frothing milk can carry proteins into the air. Another way proteins can get into the air is when the food is in a powdery form and gets disturbed, for example, when preparing foods with wheat flour, powdered milk, or dried egg powder. Last, manipulations of a food might spread some proteins into the air nearby, for example, when peel­ing an orange or cracking peanuts.

Dr. Scott Sicherer

In what settings might there be an abundance of food proteins in the air?
Examples include occupational settings, such as a bakery or food-processing factory; markets where a high concen­tration of the food is being processed or heated, such as a seafood market; and food stands or kitchen locations where foods are being heated, such
as roasting nuts, or frothing milk at a coffee shop.

Is smelling a food likely to cause an allergic reaction?
Rarely. Most smells from foods are
due to organic compounds and no
appreciable proteins. For example, the smell of peanut butter is not from any significant protein in the air. Odors from foods that are not being actively heated are unlikely to expel any appre­ciable allergenic proteins.

What kinds of symptoms might happen from airborne food proteins?
The symptoms would be similar to those from allergens such as pollen
and animal dander. Namely, people may experience itchy eyes, sneezing, runny nose, and for people with asthma,
a cough or wheeze.

Although
every allergen is
in the store, you’re
not likely to experience an allergic reaction merely from
shopping.

Can touching a food cause an
allergic reaction?
Yes, but anaphylaxis is unlikely.

What kinds of symptoms might happen from touching a food?
The most common skin symptoms are red blotches, hives, and itchiness. But touching the food does not usually cause symptoms. The skin barrier pre­vents the proteins from reaching the immune system. Younger children are often more susceptible to skin reactions from direct contact, especially if their skin barrier is compromised by eczema rashes. The eyes are also sensitive to allergens, so an allergen from the fingers rubbed into the eyes can result in sig­nificant redness and swelling.
Can a severe reaction happen from touching or smelling a food?
Rarely. If a person with asthma breathes in a large inhalation of a food allergen, he or she might experience a significant asthma attack. If a large area of abraded skin is exposed to an allergen, there may be more absorption, leading to stronger reactions. However, these are unusual circumstances. The primary concern about casual exposure to a food is transferring the food from the
fingers into the mouth.

What are some surprising mistakes
that have led to allergic reactions?
Studies have shown that sometimes parents or other family members fed
an allergen purposefully to a child with allergies, or allergic individuals pur­posefully ate foods they were allergic to, resulting in reactions. The reasons for this include curiosity, thinking a small amount would be OK, and testing to see if the allergy had resolved. If you are unsure you have an allergy, always dis­cuss this with your doctor before trying an allergen at home. Teach caretakers to do the same.
Can a person with a tree nut allergy be near oak trees with acorns?
Acorns are tree nuts, and they might be allergens if eaten, but they are too sour to eat, so there is no literature about reactions from eating them. Like other nuts, it is not likely that touching them would result in any significant allergic reactions.

Can a person with a seafood allergy
swim in the ocean?
Yes. I am not aware of any reports of a person being allergic to seawater based on an allergy to fish or shellfish. This is
ably true for several reasons. The dilution of proteins in the ocean is tre­mendous. The concentration of allergenic proteins in the water becomes irrelevant. Second, the allergenic proteins in fish or shellfish are muscle proteins that would not be directly leaching into the water.

Can a person with a fish allergy
own pet fish?
Yes, since the allergenic proteins are inside the fish and are not being eaten. However, the fish food is often made of fish and shellfish. If you are handling the food, minimize skin exposure by tapping the food into the water from
a cap or container and washing your hands afterward. The main risk here might be rubbing the fish food on your hand into your eye, causing swelling.

Can a person with a fish allergy
go fishing?
Yes, although handling the fish or
handling parts of the fish after cleaning could irritate the skin because of local­ized allergic reactions. The main risk would be of skin or eye reactions, and possibly ingestion reactions if there is transfer to the mouth. It is possible to enjoy fishing by reducing direct handling of the fish, rinsing hands afterward, and wearing gloves when possible.

Can a person with a seafood allergy go to a dolphin show or swim with dolphins?
Dolphins themselves do not have aller­genic fish proteins because they are mammals, but they are fed fish and swim in an en­closed area where dilution is less than that seen in the ocean. There­fore, there is some risk that the fish proteins they ingest are in the pool water and may cause symp­toms for a person with a fish allergy.
I have had patients develop hives from the water when splashed at shows.

Can a person with a food allergy swim in a pool with others who may have eaten the food?
When young children are snacking and swimming, there is some risk that they may share food, so supervision is needed. A better choice is not to eat while swim­ming. There is a risk of choking, as well! The small amount of residual allergens that might be in a mouth or on the body of a person who is swimming is unlikely to be relevant to the allergic swimmer because of the dilution effect of the pool. This risk might increase if people are constantly eating in the pool and spilling food and if the pool is small. However,
in most situations, there should be no significant concern about reacting to re­sidual food proteins in a swimming pool.

Can a person be allergic to seawater, pool water, or any water?
Yes, but usually this is caused by the temperature of the water. There is a problem called cold urticaria, where swimming in cold water, or coming out of a pool and getting chilled, causes hives. This is a kind of physically in­duced reaction where, we believe, the
allergy cells respond to the change in temperature. It is rare for this form of reaction to progress beyond the skin. Antihistamines are often used for treat­ment. There is another rare illness, called aquagenic urticaria, where water of any temperature on the skin causes hives, but the person can still drink water.

Can tiny shrimp (copepods) in drinking water cause an allergic reaction?
Get ready to become a little grossed out. Yes, there is a microscopic animal re­lated to shrimp that lives in freshwater and is allowed to remain in safe drink­ing water, especially from sources in geographic areas that have excellent natural water available for drinking. When sources of natural drinking water exceed government standards, the water is unfiltered, leaving these microscopic animals behind. No harmful effects have been related to these creatures. Presum­ably, if they have shellfish-relevant proteins, there is too little to trigger a reaction based on their small size and dilution effects of the otherwise safe and clean drinking water. Thus, they seem not to be a concern. If you are concerned, a home water filter could remove them.

If a cow, pig, or chicken is fed allergens, such as peanut or soy, can I be allergic to that animal’s meat?
This should not be a concern, because the animal’s meat proteins do not change based on its diet. It does not have these food proteins within its meat.

Can a person with a food allergy go shopping in a supermarket?
Although every allergen is in the store, it is not likely that allergic reactions would be elicited merely from shopping. Still, there are a few things to consider. Before seating an allergic toddler in a shopping cart, it is prudent to wipe the surfaces since it is likely that the child might suck on the handle bar or other surfaces. If a person has a shellfish al­lergy, it may be prudent to avoid the area where seafood is being steamed, as the seafood proteins may be forced into the air transiently.

Dr. Scott Sicherer is a professor of pediatrics and chief of the Division of Pediatric Allergy and Immunology at Mount Sinai School of Medicine in New York, NY. He is also a re­searcher in the Jaffe Food Allergy Institute at Mount Sinai.

On Vacation with Allergies & Asthma

Here’s what you need to know to keep your symptoms at bay and have a great trip.

If you’re planning a vacation, and you or your child has
allergies or asthma, proper planning can help you keep sneezes, sniffles, wheezing, and coughing under control. Use the following tips to make sure that allergy and asthma symptoms don’t derail your vacation fun.

Do Your Homework
Check weather and pollen forecasts for your U.S. vaca­tion choices, and then plan accordingly. For example, if you’re allergic to rag­weed, New York can be significantly better early in August rather than later.

Consider the beach or mountains. These locations are best bets for allergy fighters any time of year. Ocean breezes are generally free of allergens, and
dust mites don’t thrive at elevations above 2,500 feet. Mold spores are killed by snow.
Talk to your allergist. This is espe­cially important if you are going to travel abroad and may need vaccinations or immunizations. You also may want to talk to your allergist about where you’re going and what activities you may do. For example, locations with elevations above 5,000 feet may make breathing difficult, and cold weather can be a trigger for people with asthma. Asthmatics also should discuss activi­ties like scuba diving.

Consider the beach or mountains. These locations are best bets for allergy fighters any time of year.

Check access to medical care. If
you are going to a remote location or on a cruise, you should inquire about the type of medical care available.

Check Lodging Options
Request a nonsmoking room with air conditioning (a little more difficult when traveling abroad). Check availability of a portable HEPA (High Efficiency Particulate
Arresting) air purifier or HEPA filters for your room’s air conditioner. Find out if wood, tile, or seamless vinyl floors are available (a little less difficult when traveling abroad). Carpeting can be a breeding ground for dust mites. Consider renting a room with a kitchen or shipping food ahead if you have food allergies.

Pack in Your Suitcase
Don’t forget to put your medications in your carry-on luggage – and in the original bottles to avoid questions from airport security and customs agents. Make sure you pack quick-relief medications for
asthma and an epinephrine kit if you
or a family member has food or insect sting allergies. You also might want
to bring a topical hydrocortisone cream and an over-the-counter antihistamine.

If you’re being treated with allergy shots, make sure you get your sched­uled shot before you leave. If you
will be traveling for more than a few weeks, ask your allergist to provide a treatment dose to take with you, and
the name of a local allergist who can give you the shot.

Pack your peak flow meter and
nebulizer. These can help you monitor your breathing and deliver medication. Many nebulizers come with an adaptor you can plug into your car. If you are traveling abroad, make sure you bring an adaptor to convert the electrical
current.

Consider packing your mite-proof pillowcases to help keep dust mites under control. Bring wipes for trays and tables. This can help protect travelers with food allergies. If traveling abroad, consider bringing translated information on your allergies. This can be shared with a chef when dining out in a for­eign country.

Prepare for the Ride
If traveling
by car, keep your windows up and use your air conditioner. Consider getting your automobile’s air conditioner cleaned in advance. Travel during
early morning or late evening hours, when air quality is better and traffic isn’t as heavy. If you rent a car, ask
for one where no one has smoked.

When you travel by air, take an
antihistamine in advance. If you’re congested, use your regular medication and consider using a long-acting decongestant nasal spray before take-off and landing. Notify the airline of food aller­gies ahead of time. Get up frequently and walk around the cabin. Drink
plenty of fluids and avoid alcohol to stay hydrated. Use a saline nasal spray once every hour to keep your nasal membranes moist.

Have Asthma?

You Likely Have an Allergy as Well

Asthma is becoming an epidemic
in the United States. The number of Americans diagnosed with asthma grows annually, with 26 million cur­rently affected. And according to a new study, nearly two-thirds or more of all asthmatics also have an allergy.

The study, which is published
in the Annals of Allergy, Asthma &
Immunology, the scientific journal
of the American College of Allergy, Asthma & Immunology, found that
an astonishing 75 percent of asthmatic adults between 20 and 40 years of age, and 65 percent of asthmatic adults age 55 and older, have at least one allergy.

“Allergists have known [that] the prevalence of allergies among asthmatic children is high, at 60 to 80 percent, but it was thought allergies were not
as common in asthmatic adults,” says
allergist Paula Busse, MD, lead study author. “These findings […] can help lead to proper diagnosis and treatment.”

While asthma is frequently associ­ated with children, it is not uncommon among adults 60 years and older, affect­ing three to seven percent. This number is likely higher, however, because
asthma is often underdiagnosed in
older adults.

“Both asthma and allergies can strike at any age, and are serious dis­eases,” says allergist Richard Weber, MD, ACAAI president. “Anyone who thinks they may be having symptoms of an allergy or asthma should see a board-certified allergist. Allergists are experts in diagnosing and treating
both conditions.”

According to the ACAAI, more than 50 million Americans have an allergy,
a number that is also on the rise. Is the link between asthma and allergies a reason for the increase?

“It could be one of many [factors] creating this perfect storm for allergies,” says Dr. Weber. “Other factors, such
as the hygiene hypothesis, climate change, and an increase in awareness and education can also be reasons for this growth.”

Those who have symptoms of asthma or allergy can get tested for free through the ACAAI Nation­wide Asthma Screening Program. Screening locations can be found at acaai.org/nasp.

This article was originally published in Coping® with Allergies & Asthma magazine,
Spring/Summer
2013.

Don’t Lose Sleep Over Allergies

Are your allergies keeping you awake at night? Here are some tips to help you get a good night’s sleep.

“The most important thing to figure out
is why allergies are causing sleep to be inter­rupted. There could be a number of reasons, and it is best
to determine it by working with a physician,” says David Corry, MD, chief of the section of immunology, allergy, and rheumatology at Baylor College of Medicine in Houston, TX.

Evaluate Your Symptoms
Common symptoms of aller­gies can cause sleep disruption. For example, a drippy nose. Post-nasal drip can fall into the back of your throat at night and produce irritation in the throat, as well as a cough, caus­ing you to wake up repeatedly in the night. Inflammation that’s triggered by allergies can affect the membranes of the nose and cause swelling to the point where breathing through the nose is not possible. This forces mouth breathing, which can be irritating and cause dry mouth.

In addition, Dr. Corry points out that those who sometimes complain of allergies disrupting their sleep may not actually have allergies at all, but instead may be experiencing
gastric reflux.

Inflammation that’s triggered by allergies
can cause swelling to the point where
breathing through the nose is not possible.

“When you look at their symptoms, it’s actually that they have acid coming up through their esophagus and then spill­ing all the way into the back of the mouth and into the nose, and that acid can be very irritating and produce that drippy nose. This irritation at night can be carrying forward during the day, and people might think they have allergies, but it’s actually gastric reflux,” he says.

Things that may clue you into the fact that your symptoms are actually reflux rather than allergies include

The absence of classic symptoms of allergies, such as
itchy, watery eyes, sneezing, and cough

No reaction to typical allergens during allergy testing

The timing of the onset of symptoms – the symptoms are
not seasonal, but rather year-round

The timing of symptoms during the day – people with
allergies have symptoms during the day and when they
go outside, not just at night

For anyone who thinks they have reflux rather than aller­gies, Dr. Corry recommends consulting a gastroenterologist.

Formulate a Treatment Plan
For those who have the classic symptoms of allergies, Dr. Corry recommends dis­cussing the following treatment options with your doctor:

Antihistamines

Anti-inflammatories

Allergen immunotherapy, which involves gradually
introducing the allergen to the body and over time
reversing the immune response to that allergen

Dr. Corry also recommends using a HEPA filter in the bedroom during the day to remove allergens in the air. Leave the filter on in the bedroom with the door closed throughout the day, and then turn it off at bedtime. This allows you to breathe clean air at night while you are sleeping.

Be sure to look for sources of
water intrusion in the home that might cause mold, and check to
see if air conditioner vents are
clean. If you have severe allergies, consider removing carpets from
the home and replacing them with
a hard-surface floor.

Dr. Corry points out that those who have sleep apnea independent
of their allergies may have even more difficulty sleeping. It’s impor­tant to work closely with your physician to develop a treatment plan that allows for allergy relief and a good night’s sleep.

Enjoy the Warm Weather without the Allergy & Asthma Symptoms

With springtime upon us, many are enjoy­ing warmer weather, flowers in bloom, and more hours of daylight. Although for some, these signs of spring also bring the common frus­trations associated with allergies and asthma. Here are some tips to help you enjoy the budding spring season – with­out the allergy and asthma symptoms.

Identify Your Triggers
Each season comes with its own set of potential asthma and allergy triggers. A trigger can be something in the environment like pollen, a chemical that you are ex­posed to, stress, or emotions. In order to control your allergies and asthma, it is important to know what may trigger your symptoms and how to limit your exposure to that trigger. Dust mite
excretion, pollen, and pet dander are
all common allergens and are known triggers for people with asthma. Work with your healthcare provider to iden­tify what may be causing your asthma and allergy symptoms.

Get Ready, Get Set, Get Outside
Warmer weather brings increased out­door activity and the threat of seasonal triggers. As flowers begin to bloom, pollen and air quality may play a role in your efforts to control asthma and allergy symptoms. Common springtime triggers found outside may include
pollen, flowers, weeds, trees, grass, pol­lution, and even temperature changes.

♦
Check your outdoor air quality If you plan to move your physical activity outside, remember to scope out the
environment first and be aware of any obvious triggers. The quality of the air we breathe outdoors can be especially troublesome for people with asthma. Check daily air quality levels and air pollution forecasts in your area at AirNow.gov.

♦
Lawn and garden maintenance Be­fore working in the yard, check your local pollen count. Consider gardening in the early morning or evening when the pollen count is at its lowest. Fertil­izers and freshly cut grass can worsen asthma symptoms. When working in the yard, consider wearing a particle mask (available at hardware stores) to keep from breathing in tiny particles.

♦
It’s a bug’s life Citronella candles and bug spray may keep mosquitoes at bay, but they can also trigger an asthma episode. It may help to stay several feet away from any strong smelling candles, and when using mosquito repellent, choose lotions that are unscented instead of aerosol sprays. Other tips that may help you avoid using repellent products are to empty flower pot liners or other containers holding water, wear long-sleeved shirts, long pants, and socks when outside, and stay indoors at
sunrise and sunset when mosquitoes are most active.

Know Your Hazards from the
Inside
Many Americans follow the long-standing tradition of spring-cleaning. Dusting, vacuuming, and cleaning indoor surfaces can help
to eliminate many potential asthma
and allergy triggers, but it can also
introduce new ones into the home
environment.

♦
Beware of cleaning products While cleaning the home is important and
can eliminate triggers such as mold, ingredients in cleaning products can cause asthma and allergy symptoms. Help to reduce the impact of these chemicals by ensuring that there is good ventilation. This means that you may have to open a window or two
to increase the air circulation in the home. Look for the Environmental
Protection Agency Design for the
Environment (DfE) logo when you shop for cleaning products. For more information on what the DfE label means or for a list of approved prod­ucts, visit epa.gov/dfe.

♦
Get rid of pests (or at least decrease exposure) Pests, such as cockroaches and dust mites, can be triggers for many people with allergies and asthma. You may never have a pest-free home, but you can do your part to reduce your exposure to these tiny critters. Regular house cleaning and the use of dust-mite resistant pillow and mattress covers may eliminate the breeding grounds
for these common household bugs.

Use Medications as Prescribed
While limiting exposure to triggers
can be helpful, you can never eliminate contact from all potential asthma and allergy threats. Always be sure to use your controller medications as pre­scribed, even if you are feeling well. Remember to keep your quick-relief medicine nearby in case of a flare-up. Other tools, such as a peak flow meter and a written asthma action plan, can complement your medications.

Talk with Your Healthcare Provider
Be sure to keep your doctor informed
if you begin having trouble controlling your asthma or allergy symptoms. With your doctor’s help, you can create an asthma or allergy management plan to help keep you feeling healthy, active, and symptom-free.

Allergies and asthma shouldn’t keep you from enjoying springtime weather. For more information on lung health, call the American Lung Association Help Line at (800) 586-4872,
or visit lung.org.

Take Action Against Asthma with an Asthma Action Plan

If you have asthma, you and
your healthcare provider
should develop an asthma
action plan that gives specific instructions
for early treatment of your asthma
symptoms. An asthma action plan is a
written, individualized worksheet that
shows you the steps to take to prevent
your asthma from getting worse. It also
provides guidance on when to call your
healthcare provider or when to go to the
emergency room right away.

Your asthma action plan should include

Your name

Emergency contact information

Contact information for your
healthcare provider

Your asthma severity classification

A list of triggers that may cause an
asthma attack

Your healthcare provider will use your personal
best peak flow rate to calculate the zones in your
asthma action plan.

Asthma Zones
An asthma action
plan is divided into three zones: green,
yellow, and red. The green zone is
where you want to be on a daily basis.
In this zone, you have no asthma symptoms
and you feel good. Continue to
take your long-term control medicines,
even if you’re feeling well.

The yellow zone
means that you are
experiencing symptoms. This is where
you should slow down and follow the
steps for early treatment of asthma
symptoms, including using your quickrelief
medicine to keep your asthma
from getting worse.

The red zone
means you are experiencing
severe asthma symptoms or an
asthma flare-up. Follow the steps of
your asthma action plan, and get immediate
medical treatment if your
symptoms do not improve.

You should work with your healthcare
provider to determine your zones.
Your asthma action plan can be based
on peak flow rate or asthma symptoms:

♦ Peak Flow Rate Peak flow monitoring
is recommended for people with
moderate to severe asthma. Your peak
flow rate can show if your asthma is
getting worse, even before you feel
symptoms. Your peak flow rate is measured
with a peak flow meter. To use
your peak flow rate to determine the
zones on your asthma action plan, first
you will need to spend some time determining
your personal best. Your
personal best is the highest peak flow
number you achieve in a two- to threeweek
period. Your healthcare provider
will use your personal best peak flow
rate to calculate the zones in your
asthma action plan.

♦ Symptoms Another way to monitor
your asthma control is to track your
symptoms. Common asthma symptoms
that indicate there is a problem include
daytime symptoms (cough, wheeze, or
chest tightness), a decrease in activity
level (working, exercising, or playing),
and nighttime symptoms.

Medicines
Your asthma action plan
will also include your medicines and
instructions for what to do when you
are feeling well, what to do when you
have asthma symptoms, and what to do
when your asthma symptoms are getting
worse. It should include the names
of your medicines, how much to take,
and when to take them. The dose and
frequency may change depending on
your asthma zone.

♦ Long-term control medicines (also
called controller, maintenance, or antiinflammatory
medicines) help prevent
asthma symptoms by controlling the
swelling in your lungs and decreasing
mucus production. These medicines
work slowly but help control your
asthma for hours. They must be taken
regularly (even when you don’t have
asthma symptoms) in order to work.

♦ Quick-relief medicines (also called
rescue medicines) relieve or stop asthma
symptoms once they have started. These
medicines are inhaled, and they work
quickly to relax the muscles that tighten
around your airways. When the muscles
relax, your airways open up and
you breathe easier. Quick-relief medicines
can be used before you exercise
to avoid asthma symptoms.

What to Do in an Emergency
The red zone of your asthma action
plan tells you the steps you need to
take in an emergency situation. This
portion of your plan should include
emergency telephone numbers for your
doctor, emergency department, rapid
transportation, and family or friends to
call for support.

If you have questions about your lung health,
contact the American Lung Association’s Lung
HelpLine at (800) 586-4872 to speak with a lung
health expert.

Kick Your Exercise Routine into High Gear

And Kick Your Allergy & Asthma Symptoms to the Curb

Find relief by using
your prescribed inhaler
before you begin your
workout routine.

Each spring, many people renew their commitment to
eat healthy and lose weight. After all, bathing suit
season is right around the corner. But as health regimens
kick into high gear, many people might find that instead
of feeling good they are feeling worse. And the reason might
be due to the one thing that should be helping: exercise.

“Not only can new workout routines be difficult for those
with asthma, but several allergens can be found lurking in
health clubs, making this healthy activity bothersome for the
more than 40 million Americans that suffer from allergies,”
says allergist Richard Weber, md, president of the American
College of Allergy, Asthma & Immunology. “By understanding
what triggers symptoms, those with allergies and
asthma will be able to feel good and remain active.”

Don’t Overstep Your Boundaries
If you’re experiencing
shortness of breath, wheezing, coughing, chest tightness,
and unusual fatigue, you might have exercise-induced bronchoconstriction.
The condition affects about 10 percent of
Americans. Find relief by using your prescribed inhaler before
you begin your workout routine. Breathing through your nose,
rather than your mouth, can also help. Be sure to track your
symptoms with the online journal MyEIBJournal.org.

If you’re allergic to pollen, grass, and other environmental factors,
hit the ground running indoors.

Think Before You Eat
Whether you’ve signed up for a
diet plan or are simply opting for foods with fewer calories,
you should always
read nutrition
labels before
consuming
new items.
Many products
contain
hidden food
allergens, such
as milk, wheat,
and egg. Energy
bars can also be
loaded with allergens,
including soy and nuts.

Choose Equipment Wisely
While most exercise machines
won’t cause you to sneeze or wheeze, rubber mats,
medicine balls, and some rubber-coated free weights might.
Latex can often be found in these items, causing those with
latex allergies to develop a rash or hives. Also, beware of
disinfectant wipes and sprays used to clean gym equipment.
They can contain volatile organic compounds (VOCs), which
can spur an asthma attack or cause skin irritation.

Explore the Great Indoors
If you’re allergic to pollen,
grass, and other environmental factors, hit the ground running
indoors. Not a fan of treadmills and indoor tracks? Take
your allergy medication before heading outside, and avoid
running outdoors during midday and afternoon hours when
pollen counts are generally highest. Be sure to change your
clothes and shower immediately after finishing your workout
to remove any allergens that might be clinging to your
clothes and hair.

Opt for Comfort over Fashion
If your workout leaves
you itchy and you’ve ruled out other gym culprits, your clothing
might be to blame. Synthetic materials used in everything
from shirts to socks could be irritating your skin. Check
clothing labels, and opt for Lycra (spandex) over other synthetic
materials, as it is higher quality and less likely to
irritate your skin. Garments made of natural products can
also help. If you have a latex allergy, be wary of athletic
shoes and elastic waistbands.

To learn more about what may be triggering your symptoms and to locate an
allergist in your area, visit AllergyandAsthmaRelief.org.

Chase Away Your Allergy Symptoms for a Carefree Spring

Chirping birds won’t be the only
sound you hear this spring.
More than 50 million Americans
will be sneezing and wheezing,
thanks to seasonal allergies. And if spring
comes early again this year, allergy
symptoms will be intense and last longer
than average.

“Relief might seem impossible as
pollen counts soar, but by knowing what
triggers symptoms and how to avoid
these allergens, sufferers can lead healthy,
active lifestyles with minimal side effects,”
says allergist Richard Weber, md,
president of the American College of
Allergy, Asthma & Immunology. “Although
symptoms may not always be
severe, seasonal allergies are a serious
condition that should be properly diagnosed
and treated.”

While there are common rules to live
by in the spring, such as keeping your
windows closed, there are lesser-known
spring allergy elements that can actually
increase your symptoms. To help those
with seasonal allergies cope this spring,
we’re unveiling five surprising spring
allergy facts you might not know about.

Not only will April’s showers
bring more flowers; they might
also cause more symptoms for
people with spring allergies.

1 One Pollen, Two Pollen, Three
Pollen, More
Every year is labeled
as the worst for allergy symptoms, and
there could be some truth to that. According
to a recent study published in the
Annals of Allergy, Asthma & Immunology,
pollen counts slowly rise annually and
are expected to double by the year 2040.
This is due to economic growth, global
environment sustainability, temperature,
and human-induced changes (such as
increased levels of carbon dioxide).

2 Home Sweet Hay Fever
Where
you live can influence the severity
of your symptoms. For example,
the Asthma and Allergy Foundation of
America has ranked Knoxville, TN, as
the Spring Allergy Capital for three years
in a row. However, no matter where you
live, allergies can be a problem all year
long for some people. Talk with your
allergist about treatment options and for
tips on how to eliminate allergy triggers
in your home environment.

3 Treat Before You Sneeze
You
should start taking your allergy
medication well before the first sneeze.
Allergists recommend you begin treating
two weeks before your symptoms
typically surface. And while there isn’t
a cure for spring allergies, there is something
close. Immunotherapy, also known
as allergy shots, can modify and prevent
disease progression.

4 Pollens and Molds and Weeds,
Oh My!
A mild winter may cause
an early release of pollens from certain
trees, and a longer season may be worsened
by what is known as the priming
effect. Once people with allergies are exposed
to this early pollen, their immune
system is primed to react to the allergens,
meaning there will be little relief even
if temperatures cool down before spring
is in full bloom. If weather reports call
for a streak of warm days, go ahead and
begin taking your allergy medication.

5 April Showers Bring More
Symptoms
Not only will April’s
showers bring more flowers; they might
also cause more symptoms for people
with spring allergies. Rain can promote
plant and pollen growth. And wind
accompanying a rainfall can stir pollen
and mold into the air, which also heightens
symptoms.

Spring Allergy Rules to Live By

Know your triggers. You may think
that pollen is causing your symptoms,
but other substances may be involved
as well. More than two-thirds of
seasonal allergy fighters actually have
year-round symptoms. An allergist
can help you track down the source
of your sniffles.

Keep windows and doors shut
at home, and in your car, during
allergy season.

Stay inside during midday and
afternoon hours, which is when
pollen counts are highest.

Take a shower, wash your hair,
and change your clothes after
being outdoors.

Wear a mask when doing outdoor
chores like mowing the lawn.

Anyone with allergies and asthma should be
able to feel good, be active all day, and sleep
well at night. No one should accept less. If you
suspect you have seasonal allergies, you can
locate an allergist in your area by visiting
AllergyandAsthmaRelief.org.

’Tis the Season for Sneezing and Wheezing

All during the year, the possi­bility exists for people with respiratory problems to have allergy and asthma attacks. During the holiday season, however, more hidden dangers to health exist. Here are some tips for everyone – especially those who have asthma, allergies, or other respira­tory diseases – to stay healthy during the holiday season.

Close Contact
During the holidays, family and friends gather in celebra­tion. People are hugging and kissing hello and goodbye, and unfortunately, respiratory viruses get passed around. If you have a cold, use good judgment about close physical contact.

Irritating Odors and Cold Air
People with allergies may be exposed to smoke at parties and irritating odors. One person’s fragrant cologne is an­other’s irritant. Also, the cold winter
air may affect kids with viral illnesses and asthma. To prevent an onset of respiratory problems caused by breath­ing cold air, encourage children to breathe through their noses instead
of their mouths and cover noses and mouths with scarves to keep cold air out of the airways.

Festive Foods
Food preparation is an issue for those with food allergies. During the holiday season, it’s important to know what’s in the food you’re eat­ing. You can eat your own turkey and dressing, but what if you go to a party where the hostess makes hers with
walnuts and you’re allergic to wal­nuts? In extreme cases, you may have
to bring your own meal. However, it’s usually sufficient to let the hostess know about allergies well before the gathering, especially if kids have food allergies. Call ahead. Take time to be prepared. And don’t leave your medications at home – bring your medications with you so that you’re ready to react in
an emergency.

Gifts are seasonal delights, but consider a child’s possible
allergies before you bring goodies to the cash register.

Gift Giving
Gifts are seasonal de­lights, but consider a child’s possible allergies before you bring goodies to the cash register. Let parents make the decision about gifts, such as stuffed animals or live pets, that can trigger allergic reactions. Look for toys that don’t have strong odors associated
with them.

Frenzied Schedules
Staying up late, eating junk food, and getting excited can all trigger asthma attacks. People who have chronic problems such as asthma should pay attention to their normal pre­ventive measures and make sure they’re taking their preventive medications reg­ularly. It’s important to monitor chronic illnesses around any holidays and when on vacation since normal schedules typically aren’t being followed during these times.

Christmas Tree Allergies
Christ­mas trees are often cited as the source of allergy attacks during the holidays, but molds associated with watering live trees and the chemicals sprayed on the trees are more likely irritants. There are very few cases among people with allergies in which the Christmas tree
is the culprit.

Allergic reactions usually occur shortly after an encounter with an
allergen, such as dust mites or molds. Unpacking Christmas ornaments can trigger allergic reactions. Decorations stored in a damp basement harbor molds, dust mites, and other allergens. Moving, carrying, and unpacking these Christ­mas ornament boxes stirs up dust and transfers allergens to the hands and the respiratory system. Many people are first aware of these symptoms while decorating the Christmas tree and
erroneously assume that the tree is
the cause.

Keep ornaments and decorations stored in dry areas, off the floor, and
in plastic bags. Also, wash your hands after unpacking decorations. If you’re especially concerned about allergy symp­toms, allow others to trim the tree.

Increased Time Spent Indoors
Even though freezing temperatures bring an end to seasonal pollen allergies, millions of people experience indoor allergy symptoms because of the time spent in­doors during cold weather. Your home can actually contribute to sickness.

Forced-air furnaces circulate air­borne dust containing lint, fabric fiber, bacteria, food material, and animal dander. Three of the most common
allergens – house dust mites, animal dander, and cockroach droppings –
are worse in winter when there is
less ventilation. Changing the furnace air filter regularly can help
relieve allergy symptoms.

What’s Causing Your Asthma?

Could it be one of these non-allergic asthma triggers?

by Stephen Apaliski, MD

Breathing in the fumes that scented lotions give off can trigger your asthma, so seek
out unscented versions.

While allergic asthma trig­gers only cause problems for people who are allergic to them, non-allergic triggers can be called equal opportunity offenders. What do I mean by this?
When you are allergic, it is like
having the key that turns the switch that starts the engine of asthmatic in­flammation. No key (no allergy), no inflammation.

With non-allergic triggers (espe­cially the irritants listed below), no
key is necessary. The irritant itself pushes a start button that turns the
engine on directly. In short, if you
have asthma, any of the triggers listed here can harm or affect you. You need not be allergic.

Irritants Chemical Odors Many people with asthma cannot use cleaning agents with strong odors without triggering their asthma. Using lower irritant cleaners
or delegating the task to someone else if possible (now that’s a side benefit!) are the two means of avoiding these potent triggers.

There are some individuals, how­ever, who work in jobs and industries where exposure to chemicals happens often. Certain chemicals in the work­place produce occupational asthma. Symptoms associated with occupa­tional asthma are worse when you are at work, and better when you’re away from it. If you discover a connection between worsening asthma and chemi­cals used in your job, you will need to either use a specialized breathing pro­tection device (like a respirator) in the workplace, or you may actually have
to change jobs to prevent serious long-term health problems.

Perfumes and Scents Asthma
can be triggered by breathing in the fumes that these substances give off. These are not just perfumes or colognes that you spray or daub on your body. Also included are the scents that may accompany the detergents, soaps, and lotions you use to care for your skin
or clothes. Unscented versions of these products are plentiful in the market­place, and they are worth seeking out to ensure that you don’t unintentionally trigger your asthma.

Tobacco smoke and asthma do not mix.
If you have asthma, you absolutely should
not smoke.

Dr. Stephen Apaliski

Of course, sometimes you may
end up on the elevator with someone drenched in perfume or cologne. The best approach here is to quickly put as much clean air space between you and the offending agent as you can. This may mean stepping to a new spot in
the elevator or exiting the elevator on the next floor.

Smoke Tobacco smoke and asthma do not mix. If you have asthma, you absolutely should not smoke. Similarly, if you live with a smoker, that person should smoke outside the home, and never while riding in your vehicle.
Neither rolling down a car window
nor cracking open the back door of
the house while someone is smoking
is going to do the trick.

Other potential sources of smoke exposure include campfires, wildfires, and fireplaces, as well as some bars
and restaurants, although over time fewer and fewer commercial establish­ments are allowing smoking indoors.

Air Pollution Here in Texas, espe­cially in the summertime when the air is hot and there is very little wind, we have elevated ozone levels in the air. Unfortunately, this phenomenon is not limited to Texas; elevated ozone levels can be seen in many parts of the nation, especially in urban areas.

Ozone, a gas that cannot be seen
or smelled, is a respiratory tract irri­tant, even to people without asthma. For convenience, the government grades ozone levels from green to
yellow, orange, and red, where green represents the lowest level, and red,
the highest level.

Ozone levels seem to be at their highest levels during traffic rush hour in the late afternoon and early eve­ning. If you have asthma, ozone levels above green – especially above yellow – require your attention. During these times, outdoor physical activity should be limited. In addition, keeping win­dows in your home and vehicle closed with air vents closed or on recirculate should help. Ozone levels and alerts are readily avail­able and are typically part
of the weather forecast on
local radio and television stations. You can also check the air quality forecast for your area at AirNow.gov.

Interestingly, ozone gets the most press, but it is only one of many compo­nents of air pollution that can produce problems. Others include sulfur diox­ide and diesel exhaust particles. The total Air Quality Index (which takes into account not just ozone but these other pollutants as well) ranges from green (safe) to maroon (hazardous). Staying aware of this daily reading
can guide your decision on whether
to go outdoors or stay inside on any given day.

Medications Aspirin and NSAIDs Some peo­ple have asthma triggered by aspirin or aspirin-like drugs, such as ibuprofen
or naproxen. This class of drugs is known as NSAIDs (non-steroidal anti-inflammatory drugs).

In some people, asthma is triggered by
gastro-esophageal reflux, sometimes just called reflux or heartburn.

NSAIDs are more likely to be a problem as a trigger if you have nasal polyps and chronic sinusitis with asthma. In general, I have my asthma patients – even those without nasal polyps and chronic sinusitis but who have had problems with aspirin in the past – avoid NSAIDs. For most people with asthma and NSAID sensitivity, acet­aminophen is a safe alternative medicine to treat pain. It is best to discuss this issue with your personal physician.

In some cases, aspirin is absolutely required as a medication. In such sit-
uations, a procedure known as oral
desensitization can be successfully
accomplished under the guidance of
an allergist. Oral desensitization is the graded ingestion of aspirin, beginning with extremely low doses and progress­ing to higher and higher doses, until one reaches the standard dose, which he or she must remain on without inter­ruption every day to remain desensitized. As one might expect, this procedure does have its risks, and allergic reac­tions can be seen as the dose is raised during the process.

Beta-Blockers These medications are frequently used in the treatment of heart disease, hypertension, migraine headaches, and glaucoma. They work by blocking a cell receptor known as the beta-receptor. If asthma worsens after beginning these types of medicines,
an alternative drug needs to be used.

Other Situations Gastro-Esophageal Reflux (GERD) In some people, asthma is triggered
by gastro-esophageal reflux, some­times just called reflux or heartburn. Reflux can irritate the lungs directly
or cause nasal disease and sinusitis
that worsen asthma.

Most times, GERD is accompanied by symptoms such as heartburn, but not always. Most cases cannot be simply cured by avoidance of certain foods. In severe cases, surgery may be necessary.

Sinusitis Sinusitis, a bacterial in­fection of the sinuses, is a common complicating factor for asthmatics.
Sinusitis is treated with antibiotics.
Often brought about by allergens, smoke, and other irritants, it can often be prevented by avoiding the offend­ing substance. The use of some form
of nasal wash with saline may help as
a natural, non-medication method to treat or prevent sinusitis. In the long term, usually medications – and some­times allergy shots – may be needed to successfully treat the allergies that can lead to recurrent sinus infections.

Lastly, one important consideration is to get the influenza vaccination every fall. Influenza infection can cause ma­jor asthma problems; immunization reduces the risk.

Pregnancy While it is in the strict­est sense not an asthma trigger, I wanted to take a few moments to discuss asthma and pregnancy. In two-thirds of pregnan­cies, asthma stays at the same level or improves, but in one-third of women,
it worsens.

For pregnant women with asthma, the biggest risk to the unborn baby is not from the medications needed to control it but from uncontrolled asthma itself. An obstetrician and allergist work­ing together as a team is the best way to maximize control of the mom’s asthma and minimize risk to the unborn baby.

Exercise and Asthma Vigorous exertion will produce symptoms in many people with asthma. This is often referred to as exercise-induced bron­chospasm, or EIB for short. Asthma symptoms commonly begin six to
eight minutes into a vigorous workout. Typically, the symptoms stop with ces­sation of exertion and administration
of medications.

So, is my recommendation to avoid any type of physical exertion in people with asthma and EIB? Certainly not!

History is full of stories of elite
athletes with asthma who successfully competed in their sport. Often, the on­set of EIB symptoms can be prevented by the use of a bronchodilator inhaler 15 to 30 minutes before physical exer­tion. If you also use other medications for asthma, it is very important that you take them as directed to help prevent problems with EIB.

The times I do recommend avoid­ing vigorous exertion for asthmatics is when they are already fighting some type of illness or asthma flare-up, or when outdoor pollution levels are elevated. Exercising here may make problems worse and recovery may take longer.

Avoidance
There are many non-allergic factors that can trigger asthma. The most po­tent means of preventing problems is following a path of strict avoidance.

Dr. Stephen Apaliski has been a practicing physician for over 30 years and is board certified in pediatrics as well as allergy and immunology. He practices at the Al­lergy & Asthma Centres of the Metroplex and is on the medical staff at the Arlington Memorial Hospital in Arlington, TX.

Julie Bowen

Gets Serious about Anaphylaxis Awareness

by Jessica Webb

Emmy award-winning actress Julie Bowen keeps us laughing weekly as Claire Dunphy, the strong-willed but caring matriarch on ABC’s hit comedy Modern Family. But when her oldest son, Oliver, experienced anaphylaxis (a severe, life-threatening allergic reaction) after exposure to pea­nut butter and a simultaneous bee sting, this real-life mother of three learned that allergies are no joke.

Though Oliver, a toddler at the time, had tried peanut butter before with no issues, after this particular exposure, paired with the bee sting, he experienced an anaphylactic reaction. His face swelled up immediately, and it was clear some­thing was wrong. Julie’s family was lucky; sometimes the signs of anaphylaxis are less apparent. Here, in an interview with Coping® magazine, Julie shares her fam­ily’s story and stresses the importance of recognizing and being prepared for an anaphylactic reaction.

How did you react when you found out that Oliver had an anaphylactic reaction?
I was very frightened. My husband was on the phone with me while they were in the emergency room, and the minute Oliver had the epinephrine injected, he was better. It was immediate, so there was no doubt that this was an anaphy­lactic reaction. I had heard stories about this, but I just thought allergies were a “helicopter mom’s” problem. I thought, “Oh, my kids are healthy and strong; that’s not going to happen.” And my other two kids don’t have any allergies.

What daily precautions does your family now take to ensure Oliver’s safety?
We keep an epinephrine auto injector with us at all times, and he has one at his school. If he goes off on a play date, we put one in his backpack. I like la­beling, so I put on a label that says “medicine here.”

We want him to live a healthy, normal, athletic life where he can run around outside and not feel limited.

Have you had to make any major lifestyle changes?
I have to wash my hands after handling certain nuts, but I try not to have those in the house. And we don’t live in a bee-free world, so we just have to be careful and make sure we have his epinephrine auto injector with us and make sure it’s up to date. We want him to live a healthy, normal, athletic life where he can run around outside and not feel limited.

Do you worry about him attend­ing school?
Luckily, his school is very aware of potential life-threatening allergic reac­tions. His preschool is nut free to begin with, but the world isn’t bumblebee free. It’s important that the caregivers, teachers, and coaches – the people who are around kids a lot – know the signs and symptoms of anaphylaxis. Unlike what happened to my child, which was very dramatic and sudden, it can be more subtle, and we need the people who are watching out for our kids to know what’s going on.

Does Oliver understand how
serious anaphylaxis is?
He does. We don’t try to scare him with it. We just want him to be aware of it and understand that we know how to treat and avoid it. He has become his own best advocate. Any time there
is a new food introduced to him, he
always asks what’s in it, especially with cereal bars, cookies, muffins, and cakes – things that nuts are frequently put into. We are always looking out for him, but especially at a birthday party or something like that. It’s im­portant to ask and to check.

What message do you have for parents of children with potentially life-threatening allergies?
It can be frustrating, but with some
simple precautions, it certainly isn’t impossible to live with a child who has these allergies. Know what medications your child needs, and don’t introduce a new food to your kid when you are off on a tropical island, away from any kind of medical help. If you suspect that your child has an allergy, you should go see your doctor immediately and discuss
it with him. I’m not a doctor; I don’t even play a doctor. All I am is a con­cerned mom who had a bad experience and found out the proper way to treat my child.

Julie Bowen has joined with Mylan Specialty L.P. to launch Get Schooled in Anaphylaxis™, a health initiative aiming to increase aware­ness of and preparedness for life-threatening allergic reactions. “Anaphylaxis is a long, crazy word, and a lot of kids don’t know it or how to say it, but it doesn’t have to be scary,” Julie says. “We want to make sure that peo­ple are educated, aware, and know how to treat it and how to avoid their allergic triggers.” Learn more at www.Anaphylaxis101.com.

This article was originally published in Coping® with Allergies & Asthma magazine,
Winter
2012-2013.

Eat Well. Breathe Well.

Nutrition Advice for People with Asthma

An important part of a
healthy lifestyle is good
nutrition. Good nutrition
involves choosing healthy foods that
can work to heal and repair your body
and make it stronger against disease.

It’s important to include a variety
of foods in your diet. Each of the food
groups provides nutrients that are important
to you, and foods in one group can’t
replace those in another. Choose a variety
of foods within each food group, and
eat small amounts of fats, oils, and sweets.
Talk with your doctor or dietitian about
your specific nutritional needs. If you
have asthma, eating a healthy diet can
help you feel and breathe better.

Managing Mealtime
Shortness of
breath at mealtimes can make eating hard
work. If you use all your energy preparing
a healthy meal, you may find yourself
unable to eat or enjoy what you have
prepared. If you have asthma, it’s important
to conserve your energy in order
to get the most from your meals.

Many people with asthma feel more
short of breath when their stomach is
full. This is because the diaphragm
cannot work as well when the stomach
is full. You can satisfy your nutritional
needs, keep your stomach comfortable,
and help your diaphragm to work better
by eating smaller, more frequent meals.
Eating small, frequent meals also reduces
the chance of reflux. In addition,
plan to eat before you are too hungry
or tired. It’s important to refuel before
you hit empty.

If you
have asthma, eating a healthy diet can
help you feel and breathe better.

Relax at mealtime. Breathe evenly
while you are chewing and eating. Stop
eating if you need to catch your breath.

Use prepared foods to save time and
energy in the kitchen. Frozen meals,
prepared foods, or take-out meals from
a restaurant can make your life easier.
However, the sugar, salt, or fat content
of these foods may be higher than homemade.
Be sure to ask if you are following
a special diet. You can also double or
triple your favorite recipes when cooking
to keep your freezer full for times
when you don’t feel like cooking.

When it comes to meal preparation,
do the tasks that require the most effort
when you have the most energy. For example,
many people would agree that
grocery shopping is a tiring task. This
chore can be done when you feel freshest,
in the morning or after a rest. Better
yet, have a friend or family member pick
up your groceries for you.

Don’t stand in the kitchen when you
can sit. Bring your chopping, cutting, and
mixing projects over to the kitchen table
and sit while you prepare the food, or
keep a barstool by the kitchen counter.

Avoid that “too full” feeling by eating
less of the foods that cause gas.
Common offenders include asparagus,
beans, broccoli, Brussels sprouts, cabbage,
carbonated drinks, cauliflower,
cucumbers, melons, garlic, raw onions,
peas, peppers, radishes, rutabagas, sausage,
spicy foods, and turnips. Keep a
food diary to find out if they are a problem
for you.

Steroids and Nutrition
Some people
with asthma take steroid pills on a
regular basis. Steroid pills are strong
medicines that decrease swollen airways.
They also have some nutritional side
effects to be aware of. Steroid therapy
has the potential to interfere with the
way the body uses specific nutrients,
including calcium, potassium, sodium,
protein, and vitamins D and C.

If you take steroid pills for asthma, it
is very important to eat a well-balanced
diet. A healthy diet can make up for some
of the nutritional effects of steroid therapy.

Over a long period, steroid pills can
increase the risk of osteoporosis (loss of
calcium in the bones). Therefore, you
should eat foods high in calcium, such
as dairy products. In addition, limit salt
and foods that are high in sodium, and
decrease the amount of cholesterol and
fats in your diet to prevent other side effects.
Take certain supplements, such as
calcium, and a multivitamin. Talk with
your doctor or dietitian about specific
concerns regarding steroids and your diet.

Asthma and Reflux
Many people
with asthma also have gastroesophageal
reflux, or GERD. In this condition, the
muscle between the esophagus and stomach
is weak, and stomach contents and
acid back up into the esophagus. This
may or may not cause symptoms. Many
people with GERD can experience
heartburn, pain, sore throat, swallowing
problems, chronic cough, a choking
sensation, and aspiration. Excess weight
and dietary habits can contribute to reflux.
Here are a few recommendations
to decrease your risk of reflux and
heartburn:

Lose weight. Excess pressure in the
abdomen can cause stomach contents
to back up into the esophagus.

Avoid overeating. Choose several
small meals rather than three large meals.

Avoid eating for two to three hours
prior to bending over or lying down.

The Myths and Truths About Fall Allergies

Just when many Americans are
hoping to catch a break from
summer’s record heat waves, hay
fever season is in full bloom. Each year,
ragweed pollens begin surfacing in mid-August. Symptoms of hay fever, or
allergic rhinitis, often mirror those of
a cold, including a runny nose, sneezing,
and nasal congestion.

“Many people mistake their seasonal
symptoms for a cold instead of rhinitis
due to several allergy myths,” says allergist
Stanley Fineman, MD, president
of the American College of Allergy,
Asthma & Immunology. “Knowing the
truth about allergies and how to prevent
flare-ups can mean having a comfortable,
symptom-free hay fever season.”
Here are some myths and truths you
should know about hay fever season to
help you feel great, be active all day,
and sleep well at night.

Myth: I’m miserable all hay
fever season, but there’s nothing
I can do except suffer through it.
Truth: There are many treatments
available to ease your symptoms, including
over-the-counter and prescription
nasal sprays, medications, and allergy
shots (also called immunotherapy). There
also are new treatments on the horizon,
including one for asthma triggered by
ragweed allergies, so stay tuned. In the
meantime, track your allergy symptoms
with MyNasalAllergyJournal.org and
visit with your allergist to find relief.

Myth: I’ve never had a problem
with hay fever, so I must be sneezy
and stuffy because of a cold.
Truth: Anyone can develop an
allergy – including ragweed allergy –
later in life. Scientists think it may be
that you’ve always had the allergy, but
it might have taken exposure to another
allergen to trigger your symptoms. If
symptoms are persistent, lasting more
than two weeks, you probably have allergies.
Colds evolve, usually starting with
a stuffy nose, throat irritation, and lowgrade
fever. Common allergy symptoms
include itchy eyes and nose, as well as
sneezing, but the mucus is typically clear.

Myth: I should start taking my
hay fever medication at the first
sneeze and stop at the first frost.
Truth: Ragweed usually blooms
around mid-August (a little later in the
south), but it’s best to stay ahead of
the itching, sneezing, drippy nose, and
wheezing and begin taking medication
before symptoms start. The symptoms
can linger until the end of the season,
so wait until a few weeks after the first
frost to stop taking medication.

Myth: My hay fever and pet
allergies have nothing to do with
each other.
Truth: If you are allergic to ragweed
in addition to your dog or cat,
you may experience even more symptoms
during hay fever season. People
with ragweed allergies who also are allergic
to cats or dogs develop symptoms
faster and more severely, according
to a study published in the Annals of
Allergy, Asthma & Immunology. Your
best bet? Treat pet allergies year round
to help make hay fever more manageable.
Your allergist might also prescribe
allergy shots.

Myth: Hay fever makes me
sneeze and sniffle, but my tingly,
itchy mouth must be caused by
something else. Truth:
Actually, many people who
are allergic to ragweed have oral allergy
syndrome, also called pollen-food allergy
syndrome. It means your body is having
an allergic reaction to the proteins
that are similar in ragweed pollen and
certain fruits, vegetables, and nuts –
such as banana, cucumber, melons,
zucchini, and sunflower seeds. It’s quite
common, and it is rarely serious. Usually
it only causes an itchy, tingly mouth,
throat, or lips. But sometimes it can
cause a stomachache and, very rarely,
a life-threatening reaction called anaphylaxis.
In the event of an emergency,
seek medical attention. Follow up with
your allergist, who might prescribe
epinephrine.

Autumn Has Arrived!

Don’t Let Hay Fever Spoil It

Known to most people as hay
fever, allergic rhinitis is a
common medical problem
affecting more than 15 percent of
adults and children. It takes two
different forms:

♦
Seasonal
Symptoms of seasonal
allergic rhinitis occur in spring, summer,
and early fall. They are usually
caused by allergic sensitivity to pollens
from trees, grasses, or weeds or to airborne
mold spores.

Some people may experience both
types of rhinitis, with perennial symptoms
getting worse during specific pollen
seasons. There are also non-allergic
causes for rhinitis.

No hay. No fever. So why hay fever? Hay fever is a century-old term
that has come to describe the symptoms
of allergic rhinitis, especially when it
occurs in the late summer. However,
the symptoms are not caused by hay
(ragweed is one of the main culprits)
and are not accompanied by fever. So
the term allergic rhinitis is more accurate.
Similarly, springtime symptoms
are sometimes called rose fever, but it’s
just coincidental that roses are in full
bloom during the grass-pollinating season.
Roses and other sweet-smelling,
showy flowers rely on bees, not the wind,
for pollination. Not much of their pollen
gets into the air to cause allergies.

Is there any escape?
A common
question from people with allergic rhinitis
is Can I move someplace where my
allergies will go away? Some allergens
are tough to escape. Ragweed (which
affects 75 percent of people with allergic
rhinitis) blankets most of the United
States. Less ragweed is found in a band
along the West Coast, the southernmost
tip of Florida, and northern Maine, but
it is still present. Even parts of Alaska
and Hawaii have a little ragweed.

Allergists seldom recommend moving
to another locale as a cure for allergies.
A person may escape one allergy to
ragweed, for example, only to develop
sensitivity to grasses or other allergens in
the new location. Since moving can have
a disrupting effect on a family financially
and emotionally, relocation should be considered
only in an extreme situation and
only after consultation with your doctor.

How is rhinitis treated?
Once allergic
rhinitis is diagnosed, treatment
options include allergen avoidance, taking
medications for symptom relief,
and immunotherapy.

♦
Avoidance
A single ragweed plant
may release one million pollen grains
in just one day. The pollen from ragweed,
grasses, and trees is so small that
the wind may carry it miles from its
source. Mold spores (which grow outdoors
in fields and on dead leaves) also
are everywhere and may outnumber
pollen grains in the air even when the
pollen season is at its worst.

While it’s difficult to escape pollen
and molds, there are ways to lessen
exposure. Keep windows closed and
use air conditioning in the summer, if
possible. Automobile air conditioners
help, too. Don’t hang clothing outdoors
to dry. Pollen may cling to towels and
sheets. The outdoor air usually is most
heavily saturated with pollen and mold
between 5 a.m. and 10 a.m., so early
morning is a good time to limit outdoor
activities. Wear a pollen mask when
mowing the lawn, raking leaves, or
gardening and take appropriate medication
beforehand.

♦
Medication
When avoidance measures
don’t control symptoms, medication
may be the answer. Medications help
to reduce nasal congestion, runny nose,
sneezing, and itching. They are available
in many forms, including tablets,
nasal sprays, eye drops, and liquids.

♦
Immunotherapy
Allergen immunotherapy,
known as allergy shots, may
be recommended for people who don’t
respond well to treatment with medications,
experience side effects from
medications, have allergen exposure that
is unavoidable, or desire a more permanent
solution to their allergic problem.
Immunotherapy can be very effective
in controlling allergic symptoms.

There are many hay fever remedies,
and each person’s treatment must be
individualized based on the frequency,
severity, and duration of symptoms
and on the degree of allergic sensitivity.
It’s important to talk to your doctor
about ways to reduce your fall allergy
symptoms.

Traveling with Food Allergies

Research local restaurants where you will be staying. Call ahead and ask to speak to a
manager about your needs, fully explaining how dangerous your or your child’s food allergies
can be.

Whether you’re traveling for
business or pleasure, careful
preparation can make
your trip safe and enjoyable. As always,
communication is key.

When making special requests, give
as much lead time as you can to trip organizers
and airline, hotel, and restaurant
staff. Bring a kit with all your medications,
including antihistamine, extra
autoinjectors, and copies of your emergency
medical plan. Let your doctor
know you’re traveling, and ask if he’ll
be available to fax or call in a prescription
for additional autoinjectors should
you need them.

On The Plane
Always check the
latest rules about what you can carry onboard.
There may be different regulations
for domestic and international flights. To
know before you go, visit TSA.gov.

Just as you compare carriers for the
most reasonable airfares, it’s also important
to find out how accommodating
they are to people with food allergies.
It’s a good idea to make your reservations
directly with the airline – rather
than booking through an agent or online
– so there’s no confusion later on.

Explain your situation clearly and
politely. If you or your child has a peanut
allergy, ask if the airline can serve
pretzels rather than peanuts on your
flight. And ask if it’s possible for the
flight attendants to vacuum the area
where you will be sitting before anyone
boards the plane. This is helpful in
case peanuts were served on previous
flights. Try to get all communications
in writing (ask for faxes, and print out
email communications). Confirm and
reconfirm, and keep a record of each
person you spoke with.

Before booking your stay, call and speak to
a hotel manager or director and explain the
accommodations you require.

Check in early so you can speak
to representatives at the gate as soon
as possible. After you have checked
in, explain your situation to the gate
agent, who can then remind the flight
crew about it. Once you board the
plane, remind the head flight attendant
as well.

Keep an eye on small children
with allergies. Even if flight crews
clean the area where a child is sitting,
food often falls into cracks and spaces
not reachable by a vacuum. If children
reach for a toy they dropped or
are curiously exploring the plane, they
risk coming in contact with a hidden
danger. Bring wet wipes to wipe down
the seat, armrests, window areas, seatbelt
clasps, and tray table where you’ll
be sitting.

Bring extra medications and carry
them with you at all times. When flying,
you should always bring extra
doses of your autoinjector. Bring a
letter for carrying self-injectable
epinephrine, signed by your doctor,
which will allow you to bring your
medication onboard. Keep your medical
kit under your seat – if you should
need it during your flight, you won’t
have to struggle to get it out of the
overhead bin.

Bring your own food and pack extra
in case flights are delayed. Even if peanuts
aren’t served as a snack, the other
meal or snack options might contain
offending ingredients. It’s best to bring
a container of foods that you know are
safe to eat.

Restaurants
Research local restaurants
where you will be staying. Call
ahead and ask to speak to a manager
about your needs, fully explaining how
dangerous your or your child’s food allergies
can be. Can the eatery accommodate
you without a risk of cross contamination?
Will the person you spoke with be
at the restaurant while you’re there? If
not, ask for the name of the staff member
who is aware of the circumstances.

Let your doctor know you’re traveling, and
ask if he’ll be available to fax or call in a
prescription for additional autoinjectors
should you need them.

If all else fails, ask the restaurant if
it is possible for you to bring your own
bag of pasta for them to boil. It may not
be the most memorable meal you’ve ever
had, but at least you’ll be able to enjoy
being with family, friends, or colleagues.

Remind a manager or the head waiter
about your allergies before you are seated.
Present your server with a copy of your
food allergy restaurant card so that he
or she can share it with the chef. If the
wait staff doesn’t seem to understand
your situation, always trust your gut
and seek out another staff member or
manager. In fact, there may be times
when the safest choice is to not eat
there at all.

All-Inclusive Resorts
Before booking
your stay, call and speak to a hotel
manager or director and explain the
accommodations you require. Try to
speak to the same resort manager every
time, but make sure that other management
is aware of the situation. Find out
if the resort has a doctor or nurse on
site and if they’re available full time.

Ask that every restaurant, café,
snack shop, etc., be made aware that
a guest with food allergies is staying
on the premises. (However, it is still
your responsibility to make your
server aware of your food allergies
every time you dine.)

Don’t assume that just because one
eatery at the location has “safe” food,
that they all do. Ask about ingredients
and preparations at every restaurant,
café, and snack shop every time. Even
if you’ve stayed at a resort before and
had a safe experience, many things
may have changed since your last visit.
Take precautions as if this were your
first visit.

Traveling Abroad
Find out if there
are local doctors in the area who specialize
in allergy treatment. Will they
be able to write you a prescription for
additional autoinjectors or medications
if you need them? Where is the
closest hospital?

Ask your doctor to write a prescription
that you can carry with you.
Learn the generic and brand names
in the countries you’ll be visiting. Ask
for recommendations for restaurants,
hotels, and activities. Does your doctor
treat others who have had good experiences
at certain places?

Bring several copies of your authorization
of emergency treatment,
emergency medical plan, and food
allergy restaurant cards in both English
and the language of the countries
where you will be. Make sure they are
with you at all times.

Language barriers can be tough
to deal with, but chances are there is
someone who speaks English working
at the hotel. With many Internet
translation services available, email
can be an effective way to correspond.

Bring non-perishable food that
is safe for you to eat. Dried pasta and
allergen-free snack bars are good options.
Don’t assume that the same
products manufactured in other countries
will contain the same ingredients.

It’s Summer!

Skip the Allergies, Not the Fun

Millions of Americans have
nasal allergies, commonly
known as hay fever. Often
fragrant flowers are blamed for the uncomfortable
symptoms, yet they are
rarely the cause; their pollens are too
heavy to be airborne.

Allergy symptoms appear when the
immune system reacts to an allergic
substance that has entered the body as
though it was an unwelcome invader.
The immune system will produce special
antibodies capable of recognizing
the same allergic substance if it enters
the body at a later time.

When an allergen reenters the body,
the immune system rapidly recognizes it,
causing a series of reactions. These reactions
often involve tissue destruction,
blood vessel dilation, and production of
many inflammatory substances, including
histamine. Histamine produces common
allergy symptoms such as itchy, watery
eyes, nasal and sinus congestion, headaches,
sneezing, scratchy throat, hives,
and shortness of breath. Other less common
symptoms are balance disturbances;
skin irritations, such as eczema; and even
respiratory problems, like asthma.

One of the most significant causes of
allergic rhinitis in the United States is
ragweed. It begins pollinating in late
August and continues until the first frost.
Late springtime pollens come from
grasses, and early springtime hay fever
is most often caused by pollens of trees.
Flowering plants rarely cause allergy
symptoms.

Reducing Your Exposure

♦ Wear a pollen mask when mowing
grass or cleaning house (most drugstores
sell them). ♦ Change your air filters in heating and
air conditioning systems and vacuum
cleaners regularly, or install an air
purifier. ♦ Keep windows and doors closed
during heavy pollen seasons. ♦ Wipe down pets as they return inside
to remove pollen from their fur. ♦ Use saline nasal rinses to cleanse
your nose and sinuses of the offending
allergens. ♦ Rid your home of sources of mildew. ♦ Try not to allow dander-producing
animals into your home and bedroom.
However, if you have a pet, ask your
doctor for suggestions on how to enjoy
your pet while also enjoying a life free
of allergies. ♦ Replace feather pillows, wool blankets,
and wool clothing with cotton or
synthetic materials. ♦ Enclose mattress, box springs, and
pillows in a plastic barrier. ♦ Use over-the-counter antihistamines
and decongestants as needed and as
tolerated. ♦ Sleep with the head of the bed tilted
upward. Elevating it helps relieve
nasal congestion. ♦ Discuss your hay fever and

Certain allergens are present all year
long. These include house dust, pet
dander, and some foods and chemicals.
Symptoms caused by these allergens
often worsen in the winter when the
house is closed up.

Mold spores also cause allergy problems.
Molds are present all year long
and grow both outdoors and indoors.
Dead leaves and farm areas are common
sources for outdoor molds. Indoor
plants, old books, bathrooms, and
damp areas are common sources of
indoor mold growth. Mold is also
common in foods.

Allergies are rarely life threatening,
but they often cause lost workdays, decreased
work efficiency, poor school
performance, and a negative effect on
quality of life. Considering the millions
of dollars spent on anti-allergy medications
and the cost of lost work time,
allergies cannot be considered a minor
problem.

For some allergy fighters, symptoms
may be seasonal, but for others, allergy
symptoms produce year-round discomfort.
Symptom control is most successful
when multiple approaches are used simultaneously
to manage the allergy. They
may include minimizing exposure to
allergens, desensitization with allergy
shots or drops, and medications. If used
properly, medications, including antihistamines,
nasal decongestant sprays, steroid
sprays, saline sprays, and cortisone-type
preparations, can be helpful. Even over-the-counter drugs can be beneficial.

If you are experiencing allergy symptoms,
schedule an appointment with your
doctor. Aside from gathering a detailed
history and completing a thorough examination
of your ears, nose, throat, and
head, your doctor can offer advice on
proper environmental control. He or
she will also evaluate your sinuses to
determine if infection or a structural
abnormality (deviated septum, polyps)
is contributing to your symptoms.

In addition, your doctor may test to
determine the specific allergen that is
causing your discomfort and can help
you develop a management plan that
will help make life more enjoyable.
In some cases, allergy shots or allergy
drops may be recommended.

Source: American Academy of Otolaryngology – Head
and Neck Surgery, entnet.org

This article was originally published in Coping® with Allergies & Asthma magazine,
Spring/Summer
2012.

Putting Your Finger on the Asthma Trigger

If you have asthma, you can
minimize your symptoms and
improve your quality of life
by avoiding your asthma triggers and
working with your doctor to develop a
treatment plan.

Triggers
People with asthma have
recurrent episodes of airflow limitation,
often from inflamed airways that become
narrowed, making it more difficult to
move air in and out of their lungs. This
can cause wheezing, cough, chest tightness,
and shortness of breath.
It is important to understand what
triggers your symptoms and what makes
them go away.

♦
Tobacco smoke, which is an irritant,
often aggravates asthma. No one should
smoke around you, in your home, or in
your car. Your asthma may also be irritated
by strong odors or fumes, weather
changes, and air pollution.

♦
Viral and bacterial infections, such
as the common cold and sinusitis, can
make asthma worse.

♦
Strenuous exercise or exposure to
cold, dry air can trigger asthma.

♦
Acid reflux, even if you do not experience
heartburn, is also an asthma
trigger. This diagnosis can be hard to
make, and treatment is different from
most asthma medications, so talk to
your doctor.

♦
Some medications can cause or
worsen asthma. These include aspirin
or other non-steroidal anti-inflammatory
drugs (such as ibuprofen) and beta-blockers
(used to treat heart disease,
high blood pressure, migraine headaches,
and glaucoma).

♦
Even eating certain foods can trigger
wheezing in some people. If any foods
seem to trigger an asthma attack, avoid
eating that food and talk to your doctor.

♦
Emotional anxiety may also increase
your asthma symptoms and trigger an
attack. Proper rest, diet, and exercise
are important for your overall health and
can help in managing asthma.

♦
Many people with asthma have allergies,
which can trigger asthma symptoms.
Common allergens include house dust
mites, animal dander, molds, pollen,
cockroach droppings, and foods. Your
doctor can identify what you are allergic
to and recommend ways to avoid
exposure to your triggers.

Treatment and Management
Asthma has different causes in different
people; therefore, individualized
therapy is wise. Personalized plans for
treatment may include environmental
control measures to avoid your asthma
triggers, medication, an asthma action
plan, and a partnership among you,
your family, your doctor, and other
healthcare providers.

Many people with
asthma have allergies,
which can trigger
asthma symptoms.

Since asthma is a chronic disease,
it requires ongoing management. This
includes using proper medications to
prevent and control your asthma symptoms
and to reduce airway inflammation.
There are two general classes of asthma
medications: quick-relief and long-term
controller medications. Your doctor may
recommend one or a combination of two
or more of these medications.

Quick-relief medications are used to
provide temporary relief of symptoms.
They include bronchodilators and oral
corticosteroids. Bronchodilators, generally
called “rescue medications,” open
up the airways so that more air can flow
through. Bronchodilators include betaagonists
and anticholinergics and come
in inhaled, tablet, liquid, or injectable
forms. There are some corticosteroids
designed for short-term use that are
swallowed or given by injection and
that work a bit more slowly to help
treat particularly bad inflammation in
your airways.

Long-term controller medications
are important for many people with
asthma and are taken on a regular
basis (often daily) to control airway
inflammation and treat symptoms in people
who have frequent asthma symptoms.
Inhaled corticosteroids (there are many
different ones), cromolyn or nedocromil,
and leukotriene modifiers can help
control the inflammation that occurs in
the airways of most people who have
asthma. One medication may work
better for you than another. Your doctor
can help guide you.

Inhaled long-acting beta2-agonists
are symptom controllers that open your
airways and may have other beneficial
effects, but in certain people, they may
have some risks. Current recommendations
are for them to be used only along
with inhaled corticosteroids. Methylxanthines
provide modest opening of
the airways and may have a mild antiinflammatory
effect. Theophylline is the
most frequently used methylxanthine.
Leukotriene modifiers are also used
for airway opening. Omalizumab is
an injectable antibody that helps block
allergic inflammation. It is used in
people with persistent allergic asthma.

Your asthma medications may need
to be adjusted as you and your asthma
change, so stay in close touch with your
doctor. The better informed you are
about your asthma triggers and management,
the better your asthma symptoms
will be. Together, you and your doctor
can work to ensure that asthma interferes
with your daily life as little as
possible.

Staying Active with Asthma

Staying active and exercising has many benefits to your overall health and well-being, but if you have asthma, you may feel the need to limit your activity to avoid symptoms. Understanding your symptoms and how to manage them is the first step to creat­ing an asthma management plan to keep you in the game.

When we exercise, we breathe harder, which causes water loss from our lungs. This water loss drops the temperature of our lungs and can cause asthma symp­toms. Symptoms may include coughing, wheezing, a feeling of chest tightness, and shortness of breath. You may experience symptoms once you begin exercising, or soon after it ends. How­ever, asthma doesn’t have to keep you on the sidelines.

Create an Asthma Management Plan
The first step to starting any exer­cise plan is to talk with your healthcare provider. Let him or her know what sports and physical activities you would like to participate in, and discuss the symptoms you experience during exer­cise. Remember to share any concerns or fears you may have. Together, you can create an asthma action plan that keeps you in the game and not on the sidelines.

Consider physical activities that have
periods of inactivity, such as baseball.

Keep medications on hand. Your doc­tor may recommend that you take your quick-relief medicine prior to activity to help avoid asthma symptoms. Keep your quick-relief medicine close by in case you have trouble breathing. Stop activity and use your quick-relief medi­cine as soon as you begin to have asthma symptoms. Make sure to take your med­ications as prescribed.

Assess your symptoms daily, as well as before exercising. The key to keeping your asthma well controlled is to monitor your symptoms every day. If prescribed by your healthcare provider, a peak flow meter reading can show signs of asthma symptoms before you feel them.

Start Exercising
Find the exercise that’s right for you. Consider physical activities that have periods of inactivity, such as baseball. Swimming is often a good choice since the warm, moist air may keep symptoms away. It’s important to warm up and cool down. Ease your body into physical activity with a long warm-up routine and make sure to cool down afterward. When working out in the gym, lower the intensity of your training by increasing the number of rest periods between repetitions and machines. If you begin to feel symptoms, stop activity immediately, take your quick-relief medication, and follow your asthma action plan.

Keep your trainer informed. Share the steps on your asthma action plan with your trainer. Your asthma action plan should specify what to do in case of a breathing emergency, as well as make suggestions to modify your activ­ity depending on your peak flow meter readings. It’s important to communicate with your trainer if you need longer warm-ups and cool-downs or additional rest periods during activity.

Be careful when exercising indoors. Local gyms will keep you warm during your winter workout and cool during the summer, but they may increase your risk of being exposed to asthma triggers, as well as germs. When choos­ing a gym, ask what types of cleaners and disinfectants are used since bleach and strong odors from cleaning chemi­cals can cause asthma symptoms. Make sure the pool area is well ventilated and doesn’t have the strong smell of chlo­rine. A well-ventilated gym will reduce your exposure to mildew, mold, and other asthma triggers.

If you plan to move your physical activity outside, scope out the envi­ronment first and be aware of any obvious triggers. Look for areas that aren’t close to major highways with increased automobile exhaust. Monitor air quality forecasts before heading outside. Air pollution can be very
high in the summer, and those with asthma and other lung diseases are
at higher risk for being harmed by
air pollution.

Stay Healthy
Remember to get a yearly flu shot. One of the main causes of asthma episodes is a respiratory in­fection, like the flu. Make sure to clean your gym equipment prior to use and wash your hands frequently. If you smoke, make a plan to quit.

Don’t Kill the Birthday Girl

by Sandra Beasley

There are only two birthdays that stand out in my memory as dis­tinct, chronologically certain events. One: my sixteenth birthday, when we watched Ferris Bueller’s Day Off. That was the year my friend Elizabeth, while using the swing anchored to the underside of our second-story deck, pushed off so hard that the whole she­bang – girl, swing, unhooked chains – went sailing twenty feet out into the woods behind our house. Two: the year I got diagnosed with mononucleosis, too late to cancel an Italian-themed dinner party. So I stood in front of a stove for two hours – achy, glands swollen, stone-cold sober – cooking pasta for two dozen while my friends went through six bot­tles of wine. That was, undoubtedly, my twenty-first birthday.

Beyond that, it blends into a murky party. Which years did we go to Chuck E. Cheese’s? When did I get my Rain­bow Brite doll? Which years were my father home, and which years had the army sent him off to the War College, Saudi Arabia, Bosnia?

There is one constant in my birthday memories. When it came time for a cake, my mother would bring out whatever Sandra-friendly sweet she’d designed. Some years it was sunflower-margarine Rice Krispies treats, and some years it was an applesauce-and-cinnamon-raisin Bundt cake. I’d get my serving. Then we’d dish out the real dessert of cake or brownies or pie a la mode for everybody else. After singing, after blowing out candles, after presents had been opened, after everyone had eaten, someone would say it: “Now, don’t kill the birthday girl.”

When it came time for a cake, my mother would bring out whatever Sandra-friendly sweet she’d designed.

Which meant no kisses, no hugs,
no touch of a hand or mouth. From that point onward, anyone who touched me ran the risk of giving me hives, or worse. Even today, it’s a phrase I repeat as
part joke and part prayer. Don’t kill the birthday girl.

It’s the same at every holiday. My uncle Jim is notorious for forgetting about my allergies, holding out a dish of ice cream and asking, “Want a bite?” He’s the fun bachelor uncle, the one who rides a motorcycle and would give a little girl a windup sewer rat, complete with blinking red eyes, as a Christ­mas gift.

Once upon a time, it would fall on my mother to protect me at the end of the night, when the aunts and uncles and cousins were making the rounds for good-byes. Now I step to the side on my own. Everyone understands why I avoid con­tact. Yet I can’t help but wish it wasn’t their last impression of me before the long drive home.

I am allergic to dairy (including goat’s milk), egg, soy, beef, shrimp, pine nuts, cucumbers, cantaloupe, honeydew, mango, macadamias, pistachios, cashews, swordfish, and mustard. I’m also aller­gic to mold, dust, grass and tree pollen, cigarette smoke, dogs, rabbits, horses, and wool. But in particular, I am one of the 15 million Americans who have been diagnosed with food allergies, a figure that includes 8 percent of all children. Even with so many of us in the conver­sation, there are huge disconnects in the dialogue. Parents who have never met a food they couldn’t eat struggle to
empathize with their child’s allergies. Those crusading for community accom­modation misguidedly conflate allergies with intolerance and confuse discomfort with anaphylaxis. Advocacy groups focus on youth allergies and largely ignore the complexities faced by those who grow into adulthood, travel, marry, and must figure out how to raise children of their own. There are multiple dimen­sions of data out there, but no one has set the gyroscope spinning.

Allergies are quirky beasts. Unlike many syndromes, they are primarily sorted according to their outside cata­lysts. (Have you ever heard someone claim to have type-peanut diabetes? Eggplant flu?) Allergies are widespread – and widely misdiagnosed. There is a whole range of symptoms and degrees of sensitivity, and these symptoms can change for any given individual at any time. For those with allergies like mine, each day requires vigilance in terms of what we do, the company we keep, and where we sit in relation to that bowl of mixed nuts. One person’s comfort food is another person’s enemy. One person’s lifesaver is another’s poison.

I thought my family’s habit of calling the foods I can eat “Sandra-friendly” was unique, until I saw a book by Emily Hendrix called Sophie-Safe Cooking:
A Collection of Family Friendly Recipes That Are Free of Milk, Eggs, Wheat, Soy, Peanuts, Tree Nuts, Fish, and Shellfish. The more I have read, the more I real­ize a whole culture of catchphrases has emerged in addition to the key medical terminology. Safe, friendly, free: these words come up over and over again in literature about allergies.

Don’t kill the birthday girl. Leftover omelet clings to the edge of a breakfast plate. Butter greases the stir-fry. Walnuts go commando in an otherwise tame brownie. There’s a reason they’re called allergy “attacks”; you never know where a food can be lurking.

But those with food allergies aren’t victims. We’re people who – for better or for worse – experience the world in
a slightly different way. This is not a story of how we die. These are the sto­ries of how we live.

Sandra Beasley is an author and poet who lives in Washington, D.C., where her prose has been featured in the Washington Post Magazine.

5 Surprising Summer Allergy & Asthma Triggers

Summer means barbeques, festi­vals, and other outdoor activities, and if you experience allergic reactions to grass pollens, you might be running for cover. However, seasonal allergies can also affect those without pollen sensitivities due to unexpected summer staples, such as certain fruits and vegetables, campfires, and changes in the weather.

“Although symptoms may not always be severe, summertime allergies and asthma are serious and, in some cases, deadly,” says allergist James Sublett, MD, chair of the American College of Allergy, Asthma, and Immunology Public Relations Committee. “However, these conditions shouldn’t damper summer fun. Proper diagnosis and treatment involves more than just relieving symp­toms; it can find the source of your suffering and stop it.”

By planning, seeing an allergist, and knowing the causes of allergy and asthma, even those with the most sensitive noses and lungs can enjoy summer festivities. Here are five surprising summer allergy and asthma triggers, as well as some sug­gestions for coping with them.

Toasting marshmallows or sitting out at a bonfire is a lot less fun if it results in an asthma attack.

1 Summer Fruits and Veggies
An otherwise healthy snack can mean an oral allergy syndrome for people whose lips begin to tingle after sinking their teeth into a juicy peach – or melon, apple, celery, or other fresh fruits and vegetables. People with common grass allergies can also have this condition, which is a cross-reaction between similar proteins in certain fruits and vegetables and the allergy-causing grass, tree, or weed pollens. The simple solution is to avoid the offending food, or just put up with the annoying but short-lived (and seldom dangerous) reaction. If symp­toms are bothersome, see an allergist
to identify the offending pollen and develop a treatment plan to find relief.

2 Changes in the Weather
Be it sti­fling humidity or a refreshing cool breeze, sudden changes in the weather can trigger an asthma attack. Wind can spread pollen and stir up mold, affect­ing those who have grass or tree pollen and mold allergies. Your doctor can help you develop an allergy and asthma action plan to ensure your symptoms are kept in check no matter the season or the temperature.

3 Campfire Smoke
Toasting marsh­mallows or sitting out at a bonfire is
a lot less fun if it results in an asthma attack. Smoke is a common asthma trigger. Sit upwind of the smoke and avoid getting too close to help prevent an asthma flare-up.

4 Stinging Insects
As if the pain isn’t bad enough, it is possible to develop a life-threatening allergic reaction to the sting of yellow jackets, honeybees, wasps, hornets, and fire ants. Cover up when gardening or working outdoors, avoid brightly colored clothing, forget the per­fume, and take caution when eating or drinking anything sweet, all of which attract stinging insects. Be especially careful with open soft drink cans. Your doctor might advise carrying epineph­rine for emergency relief in the event of being stung. See an allergist for skin testing to identify the offending insect and ask about allergy shots, which can provide life-saving protection.

5 Chlorine
Although not an allergen, the smell of chlorine from pools or hot tubs can be an irritant and cause flares of either allergy-like eye and nose symp­toms or asthma in some people.

Are You Making Your Allergies Worse?

Air filters, summer breezes, pro­crastination, and self-medication – each can delay relief from a
stuffy nose, sneezing, sniffling,
or other allergy symptoms. Be
on the lookout for the following allergy-aggravating culprits.

Using the wrong air filter
Using an air filter to keep your home pollen-free is a good idea,
but be sure it’s the right kind. Whole-house filtration systems
do work, but change the filters
regularly or you could be doing more harm than good.

Opening your windows
When your windows are open,
the pollen can drift inside, settle into your carpet, furniture, or
car upholstery, and continue to
torture you. So keep your house and car windows shut during
allergy season.

Procrastinating
You may
think you can put off or even do without medication, but the next thing you know, you’re stuffed
up, sneezing, and downright miserable. Instead, get the jump on al­lergies by taking your medication before the season gets under way.

Self medicating
Perhaps
you’re not sure exactly what’s
making you feel awful, so you switch from one medication to
the next hoping for relief. Your best bet is to see an allergist, who can determine just what’s triggering your symptoms and suggest treatment. You might even benefit from allergy shots, which can
stop your symptoms altogether.

Your Guide for Asthma-Friendly Travel

If you or a loved one has
asthma, navigating travel and
different environments can
be tricky. With a little preparation, your
travel can be more asthma-friendly.

Asthma Travel Pack Create an
asthma travel pack to ensure you have
all of the medicines and instructions
you need in one, easily accessible place.
When creating your asthma travel pack,
consider including

copies of your asthma action plan;

an extra written prescription in case
medication is lost or destroyed;

insurance card and healthcare provider
contact information;

both quick-relief and controller medications
(enough to get you through
your stay, and extra in case you get held
over unexpectedly);

a spacer or chamber, if prescribed
by your doctor; and

a peak flow meter, if prescribed by
your doctor.

Store your asthma travel pack and
medicines at the correct temperature.
Medicines may be exposed to extreme
temperatures if they are stored in luggage
checked at the airport or in your car.
If your child is traveling without you,
ensure his or her caregivers have access
to the asthma travel pack and understand
its contents, how to follow the instructions
on the asthma action plan, how to
administer medicines, and what to do
during a breathing emergency.
If you are prone to frequent asthma
symptoms or will be gone for an extended
period, it’s important to know where you
can get medical attention if needed. Ask
your healthcare provider to recommend
a doctor or healthcare facility close to
where you’ll be staying.

Prepare for Temperature Changes
When on vacation, you may be going
from a warm to a cold climate, or vice
versa. Extreme changes in temperature
can trigger asthma. Try to stay indoors
if it’s hot or humid outside, and wrap
a scarf around your nose and mouth if
it’s very cold.

Whether you are staying in a hotel or at grandma’s
house, you may be exposed to the same triggers found
in your home, and possibly new triggers.

Fly with Confidence
According
to the Transportation Security Administration,
www.tsa.gov, nebulizers are
permitted in both check-in and carry-on
luggage. It’s best to pack your nebulizer,
quick-relief, and other asthma medicines
in your carry-on, even during short
flights. It’s important to have your medicine
with you at all times. You never
know when you may get stuck on the
plane, or if your suitcase will get lost.

Choosing a Place to Stay
Whether
you are staying in a hotel or at grandma’s
house, remember that you may be exposed
to the same triggers found in your
home, and possibly new triggers. Complete
this checklist when considering
lodging:

Request a Smoke-Free Environment
Choose a hotel that is completely smokefree.
Cigarette and cigar smoke can travel
through the heating and cooling systems
into your room. If a smoke-free hotel is
not available, stay in a nonsmoking room
on a nonsmoking floor. If you are staying
with family or friends, ask to stay
with those who don’t smoke. If residents
do smoke, ask them to smoke outside.

Reduce Allergens
Some hotels now
offer rooms that minimize allergens.
They may be furnished with hardwood
floors instead of carpet, have shades
instead of fabric drapes, and use hypoallergenic
linens.

Go Fragrance Free
If strong odors
trigger your asthma, ask for a hotel room
without scented soaps, lotions, or cleaning
products. If you’re a houseguest, ask
your host not to burn candles or incense,
or use air fresheners.

Staying Warm
If you’re traveling
to a colder climate, you may gather
around the fireplace or warm your housing
accommodations with wood-burning
stoves, but their smoke can trigger an
asthma episode. Kerosene and gas
space heaters can also worsen asthma
symptoms.

Reduce Exposure to Pets
If pet dander
is a trigger, ask for a hotel room that
has not housed pets. If those hosting you
have pets, ask that the pet stay out of
the room you are staying in to reduce
your exposure. Wash your hands after
touching the pet to remove any dander.

Bring Your Own Bedding
If you use
a special pillowcase or mattress covers
to reduce dust mite exposure, consider
bringing them with you. Hypoallergenic
“sleep sacks” are designed to use when
staying in hotels to protect you from
allergens, and can be purchased at stores
that sell bedding.

Watch Out for Chlorine
Swimming
is great exercise, but chlorine and other
chemicals found in pools can trigger
asthma. Make sure the pool area is well
ventilated and doesn’t have a strong
chlorine or chemical odor.

Managing Stress
Emotions can run
high when you travel. Stress, excitement,
anger, crying, and even laughing really
hard can trigger an asthma episode. Practice
deep breathing to help reduce stress
and excitement. Try to stick to your regular
exercise routine, eat healthy, and
get plenty of rest.

Gardening the Allergy-Friendly Way

For many people with seasonal allergic
rhinitis (hay fever), getting their
hands dirty in the garden has consequences.
Sneezing, itchy eyes, congestion,
and other reactions can turn yard work
into misery. However, with a few simple
precautions, allergies don’t have to
stand between you and your garden.

The best times of day to be outdoors
are when the pollen levels are lower.
This is typically on rainy, cloudy, and
windless days. Pay attention to pollen
counts in your area by subscribing to
the email alerts available from the National
Allergy Bureau at aaaai.org/nab.
The NAB provides the most accurate
and reliable pollen and mold levels
from approximately 78 counting stations
throughout the United States, two
counting stations in Canada, and two
in Argentina.

Avoid touching your eyes or face when
doing yard work. You may also consider
wearing a mask to reduce the amount
of pollen spores that you breathe in.

Leave gardening tools and clothing
– such as gloves and shoes – outside
to avoid bringing allergens indoors.
Showering immediately after gardening
may also help reduce symptoms.

Certain flowers, trees, and grasses
are better suited for the gardens of people
with outdoor allergies (see sidebar).
The best way to determine which plants
trigger your allergic reactions is through
skin testing. Your doctor can help you
develop strategies to avoid troublesome
plants and pollen and can prescribe medication
to alleviate symptoms.

Allergy shots may offer permanent
relief from allergy symptoms. Check
with your doctor to see if this is an
effective treatment for you.

Ready or Not, Spring Allergy Season is Here

Allergies are diseases of the
immune system that cause
an overreaction to substances
called allergens. People who have allergies
can live healthy and active lives.

Good allergy treatment is based on
the results of your allergy tests, your
medical history, and the severity of
your symptoms. It can include three
different treatment strategies: avoidance
of allergens, medication options,
and immunotherapy (allergy shots).

Avoiding Your Allergens
The
best way to prevent allergy symptoms
and minimize your need for allergy
medicine is to avoid your allergens
as much as possible and to eliminate
the source of allergens from your
home and other environments. For
tips on allergen avoidance, talk to
your doctor.

Some people don’t take allergy medicines
because they don’t take their symptoms seriously.
The result may be painful complications.

Medication
Some people don’t
take allergy medicines because they
don’t take their symptoms seriously.
The result may be painful complications,
such as sinus or ear infections.
Don’t take the risk. There are so many
safe prescription and nonprescription
medicines to relieve allergy symptoms.
Following is a brief list of medications
taken for allergies. They are
available in nonprescription and prescription
form:

Antihistamines and decongestants
are the most common medicines used
for allergies. Antihistamines help relieve
rashes and hives, as well as sneezing,
itching, and runny nose. Decongestant
pills, sprays, and nose drops reduce
stuffiness by shrinking swollen membranes
in the nose.

It is important to remember that
using a nonprescription nasal decongestant
spray more than three days in
a row may cause the swelling and stuffiness
in your nose to become worse,
even after you stop using the medicine.
This is called a rebound reaction. Some
nonprescription “cold” medicines combine
an antihistamine, a pain reliever
like aspirin or acetaminophen, and a
decongestant. Aspirin can cause asthma
attacks in some people. Don’t take a
chance. If you have asthma, talk with
your doctor before taking any nonprescription
allergy medicine.

Corticosteroid creams or ointments
relieve itchiness and halt the spread of
rashes. Corticosteroids are not the same
as anabolic steroids that are used illegally
by some athletes to build muscles.
If your rash does not go away after
using a nonprescription corticosteroid
for a week, see your doctor.

Cromolyn sodium prevents the inflammation
that causes nasal congestion.
Because it has few, if any, side effects,
cromolyn can be safely used over long
periods of time.

Oral corticosteroids may be prescribed
to reduce swelling and stop severe allergic
reactions. Because these medications
may cause serious side effects, you
should expect your doctor to carefully
monitor you.

Epinephrine comes in pre-measured,
self-injectable containers, and is the
only medication that can help during
a life-threatening anaphylactic attack.
To be effective, epinephrine must be
given within minutes of the first sign
of a serious allergic reaction.

Immunotherapy (Allergy Shots)
When it is not possible to avoid your
allergens and treatment with medications
alone does not solve the problem,
immunotherapy can often prevent allergy
symptoms. It involves giving a
person increasingly higher doses of an
allergen over time. For reasons that we
do not completely understand, the person
gradually becomes less sensitive
to that allergen. This can be effective
for some people with hay fever, certain
animal allergies, and insect stings.
It is usually not effective for allergies
to food, drugs, or feathers, nor is it
effective for hives or eczema.

Skin Allergy Mobile App Available

For people who suffer from skin allergies, shopping for something simple like laundry detergent, shampoo or lotion can be a gamble that lands them in the doctor’s office. In fact, a National Ambulatory Medical Care survey conducted in 1995 estimated that 8.4 million people visit their doctor because of skin allergies, or contact dermatitis. Furthermore, allergic reactions to skin care and cosmetic products were the second most frequent dermatologic diagnosis.

But thanks to a new mobile health application from Preventice, Inc., life just got easier for people with skin allergies.

Introducing CARD for iPhone, Smartphones and tablets
The CARD application is the first publicly available application based on a technology licensed between Mayo Clinic and Preventice. CARD combines the world-class medical expertise and research of Mayo Clinic with the cutting-edge mobile technology and cloud-computing platform of Preventice.

Save photos to share with their physician to improve diagnosis and treatment

Create personal journals of any reactions

Receive notification of product formulation changes

The Preventice CARD application gives consumers access to the world’s most recognized contact allergy database, which contains more than 8,000 known ingredients found in more than 5,500 commercial skin care products. Developed by Mayo Clinic in 1999, CARD is available for the first time to physicians and patients worldwide.

“The occurrence of contact dermatitis is increasing and product labeling remains an issue, despite the growth of all-natural products,” said Jon Otterstatter, Preventice co-founder, president and CEO. “Physician and patient response to the CARD application has been extremely positive, and patient stories reinforce the real-life value that CARD offers.”

“The Preventice CARD System represents an essential clinical tool for discovering and avoiding skin-care products that cause allergic reactions,” said James Yiannias, MD, Mayo Clinic. “Dermatologists at Mayo Clinic have used CARD for years to recommend safe skin care products and have found it typically increases patient compliance and makes patient diagnosis and education more efficient.”

Seven Tips to Successfully Quit Smoking in the New Year

This holiday season, countless Americans will make the New Year’s resolution to quit smoking in 2012. While quitting smoking is extremely difficult – six out of 10 smokers require multiple quit attempts to stop smoking – preparing a quit-smoking plan can greatly improve a person's chance for success. The following are proven tips and resources from the American Lung Association that have helped thousands of people give up smoking for good:

Talk to your doctor or pharmacist about the various types of treatments and different over-the-counter and prescription medications that are available to help you quit smoking.

Look into the different options available to help smokers quit. Visit www.lung.org/stop-smoking or call 1-800-LUNG-USA (1-800-586-4872) for suggestions.

Take time to plan. Pick your quit date a few weeks ahead of time and mark it on the calendar. If you can, pick a day when life's extra stresses are not at their peak, such as after the holidays. Mark a day on the calendar and stick to it. As your quit day approaches, gather the medications and tools you need and map out how you are going to handle the situations that make you want to smoke.

Get some exercise every day. Walking is a great way to reduce the stress of quitting. Exercise is proven to not only combat weight gain but also to improve mood and energy levels.

Eat a balanced diet, drink lots of water and get plenty of sleep.

Ask family, friends and co-workers for their help and support. Having someone to take a walk with or just listen can give a needed boost.

You don't have to quit alone. Help is available online and in your community. Consider joining a stop-smoking program like Freedom From Smoking® (www.ffsonline.org) from the American Lung Association.

"Research shows that people who develop a support system and use programs like Freedom From Smoking® Online have greater success in quitting for good."

“Quitting smoking is the single most important step smokers can take to improve their health,” said Norman H. Edelman, MD, chief medical officer of the American Lung Association. “The start of a fresh New Year is a great time for smokers to implement their plan to quit smoking – and reap the health and financial benefits of a smokefree lifestyle.”

Helping Americans quit smoking remains a public health priority for the American Lung Association. Its Freedom From Smoking® group clinic program #&8211; which began in 1981 and includes a comprehensive variety of evidence-based cessation techniques – has helped hundreds of thousands of smokers quit. The American Lung Association more recently introduced Freedom From Smoking® Online, a highly successful, self-paced online adaptation of the group clinic that is available 24 hours a day.

“Smokers don’t have to go it alone when they attempt to quit smoking,” added Dr. Edelman. “In fact, research shows that people who develop a support system and use programs like Freedom From Smoking® Online have greater success in quitting for good, compared to those who try to quit “cold turkey.”

Researchers Engineer a New Way to Inhibit Allergic Reactions Without Side Effects

Researchers from the University of Notre Dame have announced a breakthrough approach to allergy treatment that inhibits food allergies, drug allergies, and asthmatic reactions without suppressing a sufferer's entire immunological system.

The therapy centers on a special molecule the researchers designed, a heterobivalent ligand (HBL), which when introduced into a person's bloodstream can, in essence, out-compete allergens like egg or peanut proteins in their race to attach to mast cells, a type of white blood cell that is the source of type-I hypersensitivity (that is, allergy).

"Unlike most current treatments, this approach prevents allergic reactions from occurring in the first place" says Basar Bilgicer, assistant professor of Chemical and Biomolecular Engineering and Chemistry and Biochemistry and principal investigator in Notre Dame's Advanced Diagnostics & Therapeutics initiative.

Michael Handlogten, lead scientist on the paper and a graduate student in Dr. Bilgicer's group, explained that among the various chemical functionalities he analyzed to be used as the scaffold HBL synthesis, ethylene glycol, an FDA-approved molecule, proved to be the most promising.

"Unlike most current treatments, this approach prevents allergic reactions from occurring in the first place."

Mast cells are part the human body's defense against parasites (such as tapeworms), and when working normally they are attracted to, attach to, and annihilate these pathogens. But type-I hypersensitivity occurs when the cells react to non-threatening substances. More common allergies are due to ambient stimulants, and an allergic response may range from a mild itch to life-threatening anaphylactic shock.

Tanyel Kiziltepe, a research professor in Advanced Diagnostics & Therapeutics, adds that "anaphylaxis can be caused by certain food allergens, insect stings, antibiotics, and some medicines, and we believe HBL has a very high potential to be developed as a preventative medication".

While many medicines treat allergies by weakening a person's entire immune system, this approach only disrupts the process whereby white blood cells bond with allergens in the first place.

"It also does not leave patients open to an increased risk for infections or the development of cancers," explains Bilgicer. "HBLs may be most useful in situations where it's not possible to speak to or gauge someone's sensitivity."

"For example, in an emergency, on a battlefield, or in a remote location, doctors may not be able to ask a patient about an allergy before administering penicillin. An engineered HBL could be given along with the medicine and perhaps prevent a deadly reaction from occurring."

In a normal allergic reaction, allergens bind to a white blood cell, or "mast" cell, and cause the release of inflammatory molecules. Researchers at Notre Dame have shown how non-allergenic molecules, known as heterobivalent ligands, can be designed to attach to mast cells first, preventing the allergic reaction in the first place.

Advanced Diagnostics & Therapeutics – a Strategic Research Investment of the University of Notre Dame – is dedicated to developing tools and technologies to combat disease, promote health, and safeguard the environment.

Dining Out with Food Allergies

Do you know what’s in that salad? When dining out, it’s always best to double check your meal for potential allergens before you dig in.

Dining out is one of America’s favorite pastimes, but for peo­ple with food allergies and intolerances, the experience can often be frustrating and stressful. Paul An­tico, founder of AllergyEats, an online source for finding allergy-friendly res­taurants, understands these challenges firsthand from dining out with his three food-allergic children.

“Families with food allergies hope that all restaurants will cater to food-allergic diners, but some restaurants are far more accommodating than others. A growing number of restaurants have extensive food-allergy protocols in place, educating their staff about food allergies and procedures, avoiding cross-contamination, and sharing detailed information about the ingredients in each dish. Other establishments are unable – or unwilling – to prepare meals without diners’ allergy triggers, such as nuts, dairy, eggs, gluten, shellfish, and more,” Paul says.

“Unfortunately, there is no such thing as a completely allergy-safe restaurant. While many restaurants have gone to great lengths to be as allergy-friendly as possible, food-allergic individuals – or their caretakers – still need to take 100 percent responsibility for their own safety,” he adds.
As the father of three food-allergic children, the founder of AllergyEats, and a proactive food allergy advocate, Paul offers the following advice based on his personal and professional experience.

Do some homework in advance.
Find dining recommendations from others within the food allergy commu­nity through an online resource like AllergyEats (www.allergyeats.com). Check menus and allergen information on res­taurants’ websites. Call the restaurant with any questions before you leave
the house.

Once you arrive at the restaurant, ask your
server how the restaurant will be able to
accommodate your specific needs.

Try to dine at off-peak hours.
When restaurant staff is less harried, they will be better able to take the proper precau­tions with your order.

Inform the host and server about your food allergies.
Once you arrive at the restaurant, ask your server how the restaurant will be able to accommo­date your specific needs. Be very clear, but polite. If you don’t feel completely confident after speaking to the server, ask to talk to the manager or chef. Most importantly, if after speaking with the restaurant staff, you don’t feel comfort­able, leave and find another restaurant.

Ask questions.
When you speak with the restaurant staff, you should receive confident answers to the fol­lowing questions:

What protocols do you have in place to serve food-allergic individuals?

Which items on your menu are not safe, given my specific food allergies?

How are diners’ allergies communi­cated to the kitchen and other staff?

How is the kitchen set up to prevent cross-contamination?

Is separate equipment used to prepare orders for food-allergic individuals?

What kind of oil will be used in the preparation of my order? Is it safe, given my allergies?

Can I see the list of ingredients for a given menu item?

Get reassurance about the safety of your food.
When you receive your meal, politely ask the server if he or she is sure that this food is safe for you and if there was any chance of cross-contamination.

Stop and look carefully at your meal.
Check to see if any of your offending allergens, such as grated cheese, pesto, or nuts, are present. This may sound obvious, but Paul has found that some restaurants follow all of the “rules” to accommodate a food allergy and then mistakenly do something as obvious as grating cheese on top of a dairy-allergic diner’s salad.

Show your gratitude. If the restau­rant answered all of your questions and accommodated your special requests, be sure to thank them, leave a generous tip, and let them know you’ll return thanks to your positive experience.

Whether your experience was posi­tive, negative, or somewhere in between, log on to AllergyEats.com and rate the restau­rant. Rating a restaurant is simple and helps other food-allergic individuals determine which restaurants to visit.

Home Is Where the Sneeze Is

When you have indoor aller­gies, it’s hard to feel like “there’s no place like home.” The good news is there are some simple steps you can take to reduce your exposure to indoor allergens.

Don’t Let Dust Get Too Comfortable
If you or someone in your household has allergies, cleaning the home is incredibly important in managing exposure to indoor allergens. Regular use of a cyclonic vacuum or a vacuum with a HEPA filter, washing items in hot water, and using dust mite-proof casings can reduce allergens.

Couches, Curtains, and Cushions, Oh My
Allergens make themselves at home in fab­rics throughout the house, such as upholstered couches and chairs, bedding, curtains, and carpets.
If you can’t tear up the carpet
or remove the curtains, look
for cleaning products that will denature or deactivate dust mite matter and cat and dog dander
in fabrics in the home.

Kick the Habit
Don’t smoke indoors at any time. This benefits everyone.

When in Doubt, Air It Out
Clean and disinfect bathrooms, kitchens, and basements regularly, and keep them well ventilated to reduce the growth of mold. Use exhaust fans or open a window when cooking or bathing.

Keep Fido Allergy-Friendly
Can’t live without pets? Bathe them once a week to reduce dan­der, and whenever possible, keep your pet out of the bedroom.

Immunotherapy Can Provide Lasting Allergy Relief

Immunotherapy treatment (allergy shots) is based on a century-old concept that the immune system can be desensitized to specific allergens that trigger allergy symptoms. These symptoms may be caused by allergic respiratory conditions, such as allergic rhinitis and asthma.

While allergy medications often con­trol symptoms, if you stop taking your medication, your allergy symptoms re­turn shortly afterward. Allergy shots can potentially lead to lasting remission of allergy symptoms, and they may even prevent the development of asthma and new allergies.

The Process Immunotherapy treat­ment involves injecting the allergen or allergens causing your allergy symp­toms. These allergens are identified by a combination of a medical evaluation performed by a trained healthcare pro­fessional and allergy skin or blood tests.

Some people have lasting remission of their allergy symptoms with immuno­therapy, but others may relapse after discontinuing treatment.

Treatment begins with a build-up phase. Injections containing increasing amounts of the allergen are given one to two times a week until the target dose is reached. This target dose varies from person to person. The target dose may be reached in three to six months with a conventional schedule of one dose increase per visit. Or it may be achieved in a shorter period and fewer visits with an accelerated schedule.

Still Working After 100 Years

In 1911, allergen immunotherapy was introduced. The earliest published successes for allergen immunotherapy were based on the work of two English scientists, Leonard Noon and John Freeman. Recognizing that pollen was the cause of hay fever, these scientists thought that they could induce immu­nity and tolerance by injecting people who had hay fever with the pollen to which they were allergic. This idea was based on the positive results of vaccines that produced protection against infec­tious disease, such as small pox.

Over the years, we’ve learned much more about allergen immunotherapy. Among the most important findings is that immunotherapy can provide long-term symptom relief for years after treatment is discontinued. Research has demonstrated that allergy immuno-therapy can be effective in treating allergic asthma, allergic rhinitis and conjuncti­vitis, stinging insect allergy, and atopic dermatitis.

The maintenance phase begins when the target dose is reached. Once the maintenance dose is reached, the time between allergy injections can be in­creased. It generally ranges from every two weeks to every four weeks. Main­tenance immunotherapy treatment is usually continued for three to five years.

Some people have lasting remission of their allergy symptoms with immuno­therapy, but others may relapse after discontinuing treatment. Therefore, the duration of allergen immunotherapy varies from person to person.

Risks involved with immunotherapy are rare, but may include serious, life-threatening anaphylaxis. For that reason, immunotherapy should only be given under the supervision of a physician or qualified physician extender (such as a nurse practitioner or physician assistant) in a facility equipped with proper staff and equipment to identify and treat ad­verse reactions to allergy injections.

The decision to begin immunotherapy is based on several factors, including the length of the allergy season and severity of your symptoms, how well medications and allergen avoidance measures con­trol your allergy symptoms, and your desire to avoid long-term medication use. Immunotherapy will also require a sig­nificant time commitment during the build-up phase, and a less frequent com­mitment during the maintenance phase.

New Molecular Candidates for Treatment of Asthma and Allergies

Discovery provides new insights on role of histamine releasing factor in asthma and allergies

La Jolla Institute for Allergy & Immunology scientists have identified the histamine releasing factor (HRF) molecule as a promising target for developing new treatments for a number of allergic reactions including asthma.

The research team, led by Toshiaki Kawakami, MD, PhD, is also the first to clarify the role of the HRF molecule in promoting asthma and some allergies, including identifying its receptor - a major finding that answers a long-held and important question in the allergy research community.

Juan Rivera, MSc, PhD, deputy scientific director at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health (NIH), said the findings provide new insights on HRF's function in allergic diseases. "Importantly, this work advances both the understanding of how HRF contributes to susceptibility of certain individuals in developing allergic disease as well as begins to unravel the mechanisms involved," he said.

"What is most encouraging is the demonstration that the effect of HRF to enhance allergic responses can be blocked, thus suggesting the possibility of new therapeutic strategies in allergic diseases."

"What is most encouraging is the demonstration that the effect of HRF to enhance allergic responses can be blocked, thus suggesting the possibility of new therapeutic strategies in allergic diseases."

The research study points to the development of new therapies based on blocking HRF interactions with certain antibody (IgE) molecules, long known to be central causes of allergies. The new study also found two novel peptides (N19 and H3) as strong therapeutic candidates for blocking the HRF and IgE interactions. Peptides are protein pieces which spur various molecular actions. The two peptides inhibit the interactions of the HRF and IgE molecules, thereby stopping the allergic cascade in mouse models.

"Based on our preliminary studies, we believe these HRF inhibitors may provide a new, innovative therapeutic avenue for the treatment of asthma and some allergies," said Dr. Kawakami, lead scientist on the study, published online in the Journal of Clinical Investigation.

Hannah Gould, PhD, a professor and prominent allergy researcher at King's College in London, said the study advanced scientific understanding in several key ways. "The research community has long believed that the histamine releasing factor (HRF) played some role in triggering allergic responses and asthma in certain individuals," she said. "However, the identity of the primary binding partner, the HRF receptor, the unique characteristics of the IgE in these individuals, and the mechanisms involved in HRF activity have remained elusive until the present study by Dr. Kawakami and his team."

"These findings suggest a potential treatment for allergy and asthma patients who have HRF reactive IgE," she continued. "We can look forward to the future results of pre-clinical and clinical studies in the human system."

The prevalence of asthma has been dramatically increasing for the last few decades and has reached epidemic proportions in the U.S. and other industrialized countries. Twenty million patients suffer from asthma in the U.S. alone, including nine million children. Meanwhile, 10 to 20 percent of the population of industrialized countries suffers from some form of allergies. Both illnesses are immune system disorders.

"There is a huge need to understand these diseases and to find therapeutic interventions," said Mitchell Kronenberg, PhD, president and chief scientific officer of the La Jolla Institute, a world leader in immune system research. "Allergies and asthma are a cornerstone of the La Jolla Institute's research activities dating back to our founding scientists, who were the discoverers of the IgE molecule in the 1960s. Dr. Kawakami's latest discovery is in keeping with our history of innovation in allergy research."

Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment, referred to as allergens. When exposed to an allergen, IgE molecules activate white blood cells called mast cells and basophils. These cells release histamine and other compounds, which produces allergy symptoms that can range from uncomfortable to dangerous. In asthma, inhaled allergens can induce airway inflammation, causing wheezing, coughing and shortness of breath.

Dr. Kawakami said the HRF molecule has been studied for many years and was thought to play some role in the cellular interactions leading to allergies and asthmas. However, its exact purpose and mode of operation was previously not clear. "Nasal drainage, skin blister fluids, and some bronchial fluids were found to contain HRF secretions, so the scientific community suspected that HRF was important, but we didn't know why," said Dr. Kawakami.

HRF studies had been limited by several factors over the years, he added, including the inability to model HRF interactions in mice. In addition, Dr. Kawakami said failure to identify the HRF receptor also slowed progress. "It's very, very unusual for many years to pass between the discovery of a molecule and the identification of its receptor," he said. "In this case, 15 years had passed. Without the receptor, we couldn't understand the role of this protein in asthma and allergies."

Dr. Kawakami and his team were the first to solve this mystery in 2007 -- identifying a subset of IgE and IgG molecules as HRF receptors. This information gave Dr. Kawakami's group the critical missing piece of the HRF puzzle and enabled the researchers to map HRF's role in allergy activation.

Dr. Kawakami's team also previously discovered that tremendous heterogeneity exists in the IgE molecules. The original work, funded by NIH, provided the foundation for the latest findings on HRF's role in triggering allergies. "The differences were big in terms of affecting the activation and survival of mast cells," he said. "That's why we got interested in this molecule (HRF). Earlier studies had suggested that HRF does not bind to IgE molecules. But I was not convinced, so I decided to explore this further."

Their study results showed that 20 to 30 percent of IgE molecules can interact with HRF molecules and produce mast cell activation leading to allergies. "We think HRF is important for amplifying allergic reactions initiated by IgE and an allergen," said Dr Kawakami. The findings were published today in a paper entitled, Proinflammatory role of histamine-releasing factor in mouse models of asthma and allergy.

10 Things You Should Know about Mold

Molds produce tiny spores to reproduce. These spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot indoors, they may be­gin growing and digesting whatever they are growing on in order to survive. When excessive moisture or water accu­mulates indoors, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed.

Here are 10 things you should know about mold and how you can keep it under control.

2 There is no practical way to eliminate all mold and mold spores in the indoor environment; the way to control indoor mold growth is to control moisture.

3 If mold is a problem in your home or school, you must clean up the mold and eliminate sources of moisture.

4 Fix the source of any water problem or leak you may have to prevent mold growth.

5 Reduce indoor humidity to decrease mold growth by vent­ing bathrooms, dryers, and other moisture-generating sources to the outside; using air conditioners and dehumidi­fiers; increasing ventilation; and using exhaust fans whenever cooking, dishwashing, and cleaning.

6 Clean and dry any damp or wet building materials and furnishings within 24 to 48 hours to prevent mold growth.

7 Clean mold off hard surfaces with water and detergent, and dry completely. Absorbent materials, such as ceil­ing tiles, that are moldy may need to be replaced.

8 Reduce the potential for condensation on cold surfaces, such as windows, piping, exterior walls, the roof, or floors, by adding insulation.

9 Don’t install carpeting in areas where there is a perpetual moisture problem, such as by drinking fountains, by classroom sinks, or on concrete floors with leaks or frequent condensation.

10 Molds can be found almost anywhere; they can grow on virtually any substance, providing moisture is present. There are molds that can grow on wood, paper, carpet, and foods.

Do You Know the Warning Signs of Asthma?

Recognizing the signs and symptoms of asthma is important so that treatment and other interventions can begin early. If severe symptoms are present,
it is vital to begin the appropriate treatment immediately. Accurate and timely assessment of symptoms can help you and your doctor decide if treatment should begin in the home, at your doctor’s office, or in the emergency room.

Early Warning Signs of Asthma Early warning signs are experienced before the start of an asthma episode. By recognizing these clues, early treatment can begin. These signs can be different for each person, and they may even differ for the same person with each episode. Some early warning signs may be noticed only by the individual, while others are more likely to be noticed by other people. In ad­dition, a downward trend in peak flow numbers can be a reliable early warning sign. Additional early warning signs include breathing changes, sneezing, moodiness, headache, runny or stuffy nose, coughing, chin or throat itchiness, feel­ing tired, dark circles under your eyes, trouble sleeping, and poor tolerance for exercise.

Asthma Episode Symptoms Asthma symptoms indi­cate that an asthma episode is occurring. Changes have taken place in the airways and airflow is obstructed. Asthma epi­sode symptoms include wheezing, coughing, shortness of breath, tightness in the chest, and peak flow numbers in the caution or danger range. Individuals with asthma experience some or all of these symptoms during an asthma episode, and action should be taken to treat these symptoms before they become worse.

Severe Asthma Episode Symptoms
Severe asthma symp­toms indicate a life-threatening emergency. These include severe coughing, wheezing, shortness of breath, or tightness in the chest; difficulty talking or concentrating; experiencing shortness of breath when walking; breathing that is shallow and fast or slower than usual; hunched shoulders; nasal flaring; neck area and between or below the ribs moving inward with breathing; a gray or bluish tint to the skin, beginning around the mouth; and peak flow numbers in the danger zone.

If any of these severe asthma symptoms occur, seek emergency medical treatment right away, as these symp­toms indicate respiratory distress.

Talking with Your Doctor about Allergic Asthma

If you’re living with allergic asthma, you know what a physical and emotional rollercoaster ride it can feel like. The best way to smooth out the ups and downs is by working with your healthcare professional to identify the precise triggers of your asthma symp­toms. Once these are identified, you can take the appropriate steps toward effective treatment.

To identify your asthma triggers, your doctor will most likely collect your medical history, perform a physi­cal exam, and perform an allergy skin test that will help determine how sen­sitive you are to a specific allergen. If you’re like the majority of people with asthma, your symptoms are triggered by an allergic component that may re­quire special attention. Talking with your doctor about treatments specifi­cally for allergic asthma can offer the opportunity to develop a personalized treatment plan or to fine-tune one that already exists.

If you’re like the majority of people with asthma, your symptoms are triggered by an allergic component that may re­quire special attention.

A good place to start the conversation is by describing your asthma symptoms. Choose your words carefully, however. They can greatly affect your doctor’s assessment of your health and the sub­sequent course of treatment he or she recommends. Blood tests, skin tests, and readings from a peak flow meter all provide valuable information, but it’s your symptoms that point your doc­tor in the right direction.

In fact, you should review your symp­toms before you even enter the waiting room. Make sure you know how you would answer the following questions:

What exactly are my symptoms? Have they changed recently?

When do I find myself having them? How long do they last?

Do they prevent me from doing
normal activities like sleeping, house­work, yard work, or going to work
or school?

In addition to answering questions about your asthma symptoms, you’ll most likely be asked to describe your living conditions. For example, your doctor may want to know about your home’s location, any surrounding plant life, the type of heating system you have, the type of pillow you use, the type of fabric on your furniture, and so on. De­tails like these provide valuable clues into the cause of your symptoms and suggest possible ways to reduce your exposure to an offending allergen.

The accuracy of the information you provide is essential to finding the right treatment to target the inflamma­tion involved in allergic reactions.

The Allergy & Asthma Fighters Guide to Enjoying the Holidays

Remember that homemade items don’t come with ingredients lists.

Do allergies & asthma threaten
to be the Grinch in your hol­idays? Here are some tips to help keep your season merry.

Holiday Stress
The holidays are filled with hustle and bustle, but stress can trigger an asthma attack. Shop early or late in the day to avoid crowds. If “quiet time” isn’t a part of your normal routine, now is the time to start.

Hearth Health
Fires burning in the hearth bring warmth and ambiance to
a holiday get-together. However, the smoke and ash can smother the spirit for some, provoking breathing difficulties or triggering an asthma attack. Request the Yule log remain unlit.

O Christmas Tree
Some people can be allergic to Christmas trees. Reduce your reaction by shaking your tree thor­oughly – many vendors have a machine that can do this – and allowing it to dry for a few days in a covered area before bringing it indoors.

Fido and Fluffy
Prepare for visits to homes with pets by taking your
allergy or asthma medication before the visit. The medication may help reduce your reaction. You can also ask party hosts to keep pets in a separate room. When staying overnight with family or at a hotel, you can reduce allergic reactions to dust mites and pet dander by bringing your own allergen-proof pillow.

Homemade Goodies
Food is a cen­tral fixture in most holiday gatherings. Remember that homemade items don’t come with ingredients lists. If you or your child has food allergies, be cau­tious, especially around homemade treats. Foods can become tainted through cross-contamination in the baker’s kitchen or food storage con­tainers – and even a trace amount
can trigger a reaction.

Food Allergies vs. Food Intolerances

by Dr. Stephen Wangen

The most common example of a food intolerance
is a digestive enzyme deficiency, such as lactose
intolerance, in which a person cannot properly
digest milk products.

The terms food allergy and food
intolerance are frequently misunderstood
and misused. They
cause confusion even among doctors and
other members of the medical community.
Although they are sometimes used
interchangeably, they really refer to two
different types of physiological events.
With an allergy, the body’s immune system
attacks something that it shouldn’t.
However, an intolerance doesn’t arise
from the immune system at all. It is
important that we more thoroughly define
these two types of reactions to food.

Allergies
Allergies are reactions that involve
the immune system. The immune system
is very complex and is still not very
well understood. But basically, it functions
like a sentinel standing guard
against foreign invaders – in the case
of allergies, the invaders are allergens.
One weapon it uses against invaders
is the production of antibodies, which
cause reactions that result in the offending
allergens being removed from the
body, often via an inflammatory process.

Foods should not normally trigger
an immune response. Unfortunately,
all too often, they do, and the immune
system produces antibodies that target
the food and circulate throughout the
body, which is why an allergic reaction
can show up in such a variety of symptoms
just about anywhere in the body.
These antibodies in turn trigger inflammation,
which can result in pain and
tissue damage, leading to further symptoms.
The immune response can also
produce excess mucous or, in the case
of celiac disease, an autoimmune reaction
that damages the lining of the
digestive tract.

With an allergy, the body’s immune
system attacks something that it
shouldn’t. However, an intolerance
doesn’t arise from the immune
system at all.

It is not understood why an allergy
to a given substance is expressed so
differently in different people. Some
people get hives and swelling of the
lips and tongue. Others get digestive
problems, migraines, or arthritis. Each
individual seems to have a unique weak
point where symptoms show up first.
However, more research continues to
be published that demonstrates a connection
between various health problems
and an immune response to food.

Intolerances
Strictly speaking, food
intolerance is any type of non-immune
reaction to or problem with a food. The
most common example is a digestive
enzyme deficiency, such as lactose
intolerance, in which a person cannot
properly digest milk products.

Some people have an intolerance
to fructose, a type of sugar molecule.
A person with a fructose intolerance
does not digest or tolerate this molecule
well. Fructose is found in many foods,
such as fruits, and is derived from foods
such as corn for use as a sweetener in
processed foods. It is often listed on
labels as high fructose corn syrup.

Another example is when people
experience stomach pain or heartburn
after eating spicy food. Although this
can be caused by an allergy, in most
cases it is simply a negative reaction
to these foods that appears to have
nothing to do with the immune system.
This type of reaction also does not appear
to be an enzyme deficiency.

Other intolerances include reactions
to preservatives (such as sulfites and
nitrites), colorants (FD&C colors),
and flavorants (such as monosodium
glutamate and aspartame). There are
certainly other food intolerances, many
of which have yet to be discovered or
defined. Medically speaking, we classify
these poorly understood reactions
to foods or food additives as intolerances;
they are also sometimes called
sensitivities, another poorly defined
word. There is no technical distinction
between an intolerance and a sensitivity.
Both are catch-all terms.

Dr. Stephen Wangen is a
nationally recognized expert in the field
of gluten intolerance, a gluten-intolerant
physician, and cofounder of the IBS Treatment
Center.

Cold, Allergies, or Sinusitis?

Cold weather is a prime time for stuffy noses, sore throats, and watery, itchy eyes. But if your symptoms last more than a week, or if they seem to turn off and on based on your surround­ings, you may be battling allergies or sinusitis. Proper diagnosis and treat­ment can lead to a quicker recovery.

Colds are caused by a virus, whereas allergies are caused by exposure to allergens. Colds and allergies can both lead to sinusitis, which occurs when the sinuses become swollen and block mucus from draining, leading to pain­ful pressure and infection.

Sinusitis can last for months, even years, if not properly treated. A doc­tor can diagnose sinusitis through a physical examination, but diagnosis may also require allergy testing, X-rays, or use of a fiber-optic scope.

Colds are the most common cause of sinusitis, but people with allergies or asthma are more likely to develop sinusitis.

Colds are the most common cause of sinusitis, but people with allergies or asthma are more likely to develop sinusitis because their nasal and sinus tissue can become swollen when they breathe in triggers like dust, pollen, or smoke.

When sinusitis is caused by an in­fection, antibiotics are used to kill the bacteria. Other treatments can include decongestants, nasal sprays, hot packs, humidifiers, and saltwater rinses.

If you have allergies, there are steps you can take to reduce your risk of si­nusitis. Your doctor may recommend long-term treatments, such as allergy shots, medication to control inflamma­tion, and avoidance of allergy triggers.

Knowing whether your symptoms are caused by a cold, allergies, or si­nusitis is the first step toward choosing the proper treatment.

Soothing the Symptoms of Eczema

One common skin condition, especially in some infants and children, is atopic dermatitis, or eczema. Atopic dermatitis is difficult to treat – but it can be controlled.
Atopic dermatitis can be triggered by a number of factors, including allergy and emotional stress. It involves high levels of immunoglobulin E (IgE), the major allergy antibody, and is related to the development of other allergies, such as allergic rhinitis and asthma,
in most children.

In some people, inhaled allergens (such as dust mites, animal dander, and pollen) can cause flare-ups of atopic dermatitis. A bacterial, fungal, or viral infection also can cause a flare-up. Food allergies may trigger an episode in children, but rarely in adults. Atopic dermatitis is not contagious. Sometimes, though, scratching can lead to a bacte­rial infection.

Treating Eczema
Treatment begins with efforts to reduce the itching and inflammation, hydrating the skin, and removing the “flare factors,” such as infections and exposure to allergens and irritants. To soothe symptoms, bathe in warm (not hot) water for no more than three to five minutes. Use superfatted, unscented soap or a soap substitute. Pat your skin dry, and promptly apply a mois­turizer to help keep the skin hydrated.
Trim fingernails to reduce problems from scratching. At night, cotton socks or gloves can be worn to prevent scratch­ing while asleep. If the rash is oozing, your doctor may prescribe a lotion to dry the rash and an antibiotic to treat infection. If the rash is on the face, do not use a corticosteroid product.

Atopic dermatitis can be triggered by a number of factors, including allergy and emotional stress.

Use a humidifier in the winter to keep skin from drying out, and avoid chemi­cals and extreme heat or cold, which can worsen eczema. Use cosmetics lightly and seldom, and avoid products with perfume, dyes, and ingredients such as urea, lactic acid, or other alpha hydroxy acids.

Reduce indoor allergens, particularly dust mites, by washing bedding in hot water and removing rugs, upholstered furniture, stuffed toys, and curtains where possible. Wear gloves when doing housework. If a link with food has been diagnosed, eliminate it from your diet.

Avoid stress, which can add to flare-ups. People often feel angry and frustrated by the chronic itching. Know that with proper treatment the condition can be controlled.

Topical steroids are key for control­ling the itching and inflammation of eczema. Used immediately after bath­ing, they also help keep the skin hydrated. Antihistamines and antianxiety medi­cations may also help relieve itching. Antibiotics are used to treat complicat­ing skin infections.

Bid Bon Voyage to Allergies & Asthma During Your Winter Vacation

Preparation and prevention pave the way to successful travel for the millions of people who have allergies & asthma. The following tips can help you keep these conditions at bay while you’re on vacation.

Consider an Allergen-Free Desti­nation
Beaches and mountains are excellent year-round destinations for people with allergies. Ocean breezes are generally free of allergens, dust mites are fewer at elevations above 2,500 feet, and mold spores can’t sur­vive in snow. Check the weather and pollen forecasts of your desired destina­tion, and plan accordingly.

Pack Your Allergy and Asthma Gear
Bring your medications in your carry-on luggage, in their original packaging. Include quick-relief med­ications for asthma and an epinephrine auto-injector if you or a family mem­ber has food or insect sting allergies. Don’t forget topical hydrocortisone cream, an antihistamine, and your peak flow meter and nebulizer. Also, consider packing your own dust mite-proof pillowcases, and bring wipes
to clean trays and tables if you have food allergies.

Talk to Your Doctor or Allergist
Checking in before departure is espe­cially important if you’ll be traveling abroad and may need vaccinations or immunizations. Also, discuss where you’re going and what activities you may do. For example, locations with elevations above 5,000 feet may make breathing difficult, and cold weather can be a trigger for people with asthma. Peo­ple with asthma should also talk with a doctor or allergist before engaging in certain activities, like scuba diving.

Check Access to Medical Care
If you’re traveling to a remote location or going on a cruise, you should ask
in advance about the type of medical care available.

Prepare for the Ride
If you’re trav­eling by car, travel during early morning or late evening hours, when air quality is better and traffic isn’t as heavy. If you rent a car, ask for one in which no one has smoked. Keep your car windows closed, and use your air conditioner for temperature control. Consider get­ting your automobile’s air conditioner cleaned in advance.

When traveling by air, take an
antihistamine in advance. If you’re congested, use your regular medica­tion and consider using a long-acting decongestant nasal spray before take-off and landing. Notify the airline of food allergies ahead of time. Get up frequently and walk around the cabin, drink plenty of fluids and avoid alco­hol to stay hydrated, and use a saline nasal spray once every hour to keep your nasal membranes moist.

Accommodations
To reduce your exposure to allergens when you’re away from home, request a nonsmoking hotel room. When choosing a hotel, remem­ber that air conditioners and portable air cleaners with HEPA filters and tile, wood, or seamless vinyl floors reduce airborne allergens. If you have food allergies, consider reserving a hotel room with a kitchen so you can make your own meals. If you’re traveling to a non-English speaking destination, bring translated information about your food allergies for restaurant chefs.

Have a Sneeze-Free, Wheeze-Free Winter

Spring and fall are not the only seasons that prove troublesome for those with allergies & asthma. Winter weather causes people to spend more time indoors, where a host of household allergens can be found. For people with asthma, cold air and out­door winter activities can worsen asthma symptoms. Fortunately, there are things you can do to have a sneeze-free, wheeze-free winter.

Winter Allergies
Even though freezing temperatures bring an end
to seasonal pollen allergies, millions
of people experience indoor allergies because of the time spent indoors dur­ing cool weather. A home can actually contribute to allergy symptoms. Some common symptoms of indoor winter allergies are sneezing; runny or stuffy nose; coughing; postnasal drip; and itchy eyes, nose, and throat.
The following tips can help you keep your home free of wintertime allergens and irritants:

♦ Clean regularly.
There is no widely recognized guideline for how often you should dust and vacuum your home, but a solid cleaning once a week should help keep dust and allergen levels down. Use a damp mop for cleaning hard floors to avoid stirring up dust.

♦ Avoid exposure. If you are the one who is experiencing allergy or asthma symptoms during the winter months, have someone else in your house do
the dusting and vacuuming. When you vacuum and dust, allergens get kicked up into the air, and you can be affected if you’re around. If you can, leave the house while the cleaning is being done.

Winter weather causes people to spend more time
indoors, where a host of household allergens can be found.

♦ Crack a window. It may help to open a window or door on warmer days. Especially try to air out your house right after cleaning so the allergens
and dust you’ve kicked up have a place to escape.

♦Watch out for mold. Mold can be an irritant for some people, so be on the lookout for moisture. Good insulation can help cut down on mold by reducing condensation on cold surfaces, and dry­ing wet surfaces can keep mold from growing. Also, make sure you use your bathroom ventilation fan if you have one or crack a window while shower­ing to let the moisture escape. If you have mold, clean it up using soap and water, and then follow up with a diluted bleach mixture.

♦ Beware of gas ranges. Using gas stoves and cooktops releases nitrogen oxides into the air. These nitrogen ox­ides can irritate the lungs of individuals with asthma or other lung health issues. If you have a gas stove, make sure you use the ventilation hood in your kitchen or crack a window while cooking.

Exercise-Induced Asthma and Cold Weather Activities Unfortunately for people with asthma, skiing, snow­boarding, ice skating, and other winter sports have more than snow and ice in common – they also involve exposure to cold air, which is an asthma trigger for some people.

As with most forms of allergies, prevention is the best way to control exercise-induced asthma. This is also true for these winter sports. Fortu­nately, exercise-induced asthma can
be controlled in most cases by using your physician-prescribed asthma in­halers before exercising. (Check with your doctor before changing any treat­ment regimen.) These are safe, easy
to use, and effective.

Taking the time to warm up before exercise is important, as well. By tak­ing some time to warm up your body with light activity, you’ll have some added protection, because the body produces chemicals that protect against bronchospasm. This is not to be done instead of using your inhaler, but in addition to it. Both of these steps will lead to a better experience in these
cold weather sports, as they do in all other sports.

Coughing and wheezing, followed by shortness of breath, are signs a per­son may have exercise-induced asthma. These symptoms usually appear 5 to
20 minutes after finishing the activity. Talk to your doctor if you are experi­encing these symptoms.

Additional tips for preventing
exercise-induced asthma during winter sports include wearing a mask or scarf to warm cold air before breathing it; taking asthma medication 15 to 30 minutes before skiing, snowboarding, ice skating, or participating in other winter activities; and warming up
30 minutes before starting any cold-weather exercise or activity.

New Product Available for People with Anaphylactic Allergies

A new line of handbags and accessory cases by Epi-Essentials (epi-essentials.com) is now available for those who carry epinephrine auto-injectors, more commonly known as the EpiPen;reg;. The collection combines modern style with a medical compartment that organizes a person’s epinephrine auto-injectors and related allergy medicines, such as inhalers and antihistamines.

Crafted in colorful leather exteriors with the finest attention to details,
dual-zip compartments (one personal, one medical)
secure 2 EpiPens®, inhaler and antihistamines
with instantly visible Allergy Action & Emergency Contact cards.
A separate zip section for your "must-have" daily basics
makes every day safe, stylish and complete.The prod­ucts are available in several colors and are versatile for the lifestyles of teens, college students, and adults.

This article was originally published in Coping® with Allergies & Asthma magazine,
Winter
2011-2012.

Free Tool Promotes Adherence, Lowers Cost of Asthma

Online “Asthma PACT" Helps Patients and Parents

The Asthma PACT™ (Personal Assessment and Control Tool) available at www.AsthmaPACT.org, is a free online program hosted by the Asthma and Allergy Foundation of America (AAFA) that helps patients and parents reduce the cost and suffering from asthma. The concept is simple: individuals with asthma must follow directions from their medical providers, including medications to take, to properly treat this chronic disease. The Asthma PACT helps patients and parents to identify reasons why they may be having difficulty following the treatment plan, and it gives feedback – in written and video formats – about how to manage these problems. Individuals can print their personal assessment and take it to their medical provider for further discussion. Jacqui Vok, AAFA’s Senior Educational Programs Manager, says, "Placing the Asthma PACT personalized assessment in the hands of their physicians empowers patients to get the advice they need to help them manage their asthma symptoms." The Asthma PACT is a validated asthma adherence survey that is currently being used in research projects at the National Institutes of Health (NIH).

"Each patient is their own cost center," says Andrew Weinstein, MD, a Board Certified allergist and President of Adherence Management Systems (AMS), developer of the Asthma PACT tool. "By focusing on why you have persistent symptoms, you can improve your health and reduce your cost of care." Also, according to Weinstein, the Asthma PACT "helps the patients self-identify the ‘rough areas’ and acts as a vehicle to bring potential solutions to the individual and family."

The key to education and counseling is to know why individuals are not following the directions. This is the value of the Asthma PACT in preventing sleepless nights, work and school absence and unnecessary emergency and healthcare costs.

An estimated 25 million Americans have asthma, 7.1 million under the age of 18. The annual cost of care is estimated at $19.7 billion, with 456,000 hospitalizations and 1.5 million ER visits. African Americans are three times more likely to be hospitalized or die from asthma. Inhaled corticosteroids effectively control symptoms and reduce morbidity, mortality, health care utilization and costs.

The Right Tool for a Big Problem
Weinstein treated 59 children with severe asthma in an inpatient rehabilitation setting at the Alfred I. duPont Hospital for Children. The year prior to treatment, the median cost per patient was $10,240. Each child had seven hospital days and four emergency room visits. At all four years of follow-up, median hospital days and emergency room visits were zero. The cost of care fell below $2,000 at the end of the fourth year. The key to the success of the program was the ability of the health care team to identify the difficulties that the family was experiencing following the treatment plan and helping them become successful.

These outcomes were duplicated in the outpatient setting in children with severe asthma at the same hospital and in adult patients with severe asthma referred by Blue Cross Blue Shield Delaware. Weinstein transferred the analytic questions from his adherence care model and, in partnership with AAFA, made it available online as the Asthma PACT at no charge for all asthma patients and parents.

Adherence - The Key to Controlling Healthcare Costs
Despite high-profile discussions to control healthcare costs, there is little emphasis on the contributors to high costs, nor the actions that can be taken to reduce costs. Individuals with chronic diseases such as asthma, diabetes and heart disease are responsible for more than 80% of all health care costs due to medications, physician visits, hospitalizations, emergency care, and disability caused by these diseases. It has long been observed that 45-60 percent of individuals with these chronic diseases do not follow their prescribed medication plans, called "non-adherence" or "non-compliance," which further adds an estimated $600 million to the annual cost of care in the U.S.

Experts have identified more than twenty reasons why so many asthma patients are non-adherent; however, a partial list includes - cost; comprehension of instructions; concern about side effects; lack of support; emotional response to symptoms; disagreeing with the diagnosis; and believing the medication is ineffective.

Asthma PACT Increases Adherence, Decreases Costs
The Asthma PACT includes 75 percent of these "reasons for non-adherence" and presents them in an organized way to the patient and provider. One problem area that is now beginning to be addressed by medical schools and residency programs is the lack of counseling skills by practicing physicians. The personnel in the asthma rehabilitation program mentioned above had psychological training to help the families work through the obstacles that were preventing them from consistently giving the medication. Most individuals with asthma do not have significant psychological issues and can be helped by practitioners with basic counseling skills. But the key to education and counseling is to know why individuals are not following the directions. This is the value of the Asthma PACT in preventing sleepless nights, work and school absence and unnecessary emergency and hospital care and healthcare costs.

Visit www.AsthmaPACT.org for more information. "Asthma PACT™" and "AsthmaPACT.org" are trademarks of the Asthma and Allergy Foundation of America (AAFA). .

This article was originally published in Coping® with Allergies & Asthma magazine,
Winter
2011-2012.

Take Action Against Asthma

Take control of your asthma and
get back in action.

Taking an active role to control
your asthma involves working
with your healthcare team to
create and follow an asthma action plan.
It also means avoiding factors that can
make your asthma flare up and treating
other conditions that can interfere with
asthma management.

Asthma is treated with two types of
medicines: long-term control and quick-relief
medicines. Long-term control
medicines help reduce airway inflammation
and prevent asthma symptoms.
Quick-relief, or “rescue,” medicines
relieve asthma symptoms that may
flare up.

Your initial asthma treatment will
depend on how severe your disease
is. Follow-up asthma treatment will
depend on how well your asthma action
plan is working to control your
symptoms and prevent you from having
asthma attacks.

Your level of asthma control can
vary over time and with changes in your
home, school, or work environments
that alter how often you are exposed to
the factors that can make your asthma
worse. Your doctor may need to increase
your medicine if your asthma doesn’t
stay under control.

If your asthma is well controlled for
several months, your doctor may be
able to decrease your medicine.

On the other hand, if your asthma is
well controlled for several months, your
doctor may be able to decrease your
medicine. These adjustments, either up
or down, to your medicine will help you
maintain the best control possible with
the least amount of medicine necessary.

Asthma Action Plan You can work
with your doctor to create a personal
written asthma action plan. The asthma
action plan shows your daily treatment,
such as what kind of medicines to take
and when to take them. The plan explains
when to call the doctor or go to
the emergency room.

If your child has asthma, all of the
people who care for him or her should
know about the child’s asthma action
plan. This includes babysitters and
workers at daycare centers, schools, and
camps. These caretakers can help your
child follow his or her action plan.

Asthma Triggers A number of common
things (sometimes called asthma
triggers) can set off or worsen your
asthma symptoms. Once you know
what these factors are, you can take
steps to control many of them. For
example, if exposure to pollens or air
pollution makes your asthma worse,
try to limit time outdoors when the
levels of these substances are high in
the outdoor air. If animal fur sets off
your asthma symptoms, keep pets with
fur out of your home or bedroom.

If your asthma symptoms are clearly
linked to allergies and you can’t avoid
exposure to those allergens, then your
doctor may advise you to get allergy
shots for the specific allergens that
bother your asthma. You may need
to see a specialist if you are thinking
about getting allergy shots. These
shots may lessen or prevent your
asthma symptoms, but they can’t
cure your asthma.

Several health conditions can
make asthma more difficult to manage.
These conditions include runny
nose, sinus infections, reflux disease,
psychological stress, and sleep apnea.
Your doctor will treat these conditions
as well.

Medicines Your doctor will consider
many things when deciding
which asthma medicines are best for
you. Doctors usually use a stepwise
approach to prescribing medicines.
Your doctor will check to see how
well a medicine works for you; he or
she will make changes in the dose or
medicine, as needed.

Asthma medicines can be taken in
pill form, but most are taken using a
device called an inhaler. An inhaler
allows the medicine to go right to your
lungs. Not all inhalers are used the
same way. Ask your doctor to show
you the right way to use your inhaler.
Ask him or her to review the way you
use your inhaler at every visit.

Most people who have asthma need
to take long-term control medicines
daily to help prevent symptoms. The
most effective long-term medicines
reduce airway inflammation. These
medicines are taken over the long term
to prevent symptoms from starting.
They don’t give you quick relief from
symptoms.

If your doctor prescribes a long-term
control medicine, take it every day to
control your asthma. Your asthma symptoms
will likely return or get worse
if you stop taking your medicine.
Long-term control medicines can
have side effects. Talk to your doctor
about these side effects and ways to
monitor or avoid them.

All people who have asthma need
a quick-relief medicine to help relieve
asthma symptoms that may flare up.
These medicines act quickly to relax
tight muscles around your airways
when you’re having a flare-up. This
allows the airways to open up so air
can flow through them.

You should take your quick-relief
medicine when you first notice your
asthma symptoms. If you use this
medicine more than two days a week,
talk with your doctor about how well
controlled your asthma is. You may
need to make changes in your asthma
action plan.

Carry your quick-relief inhaler
with you at all times, in case you need
it. If your child has asthma, make
sure that anyone caring for him or her
and the child’s school has the child’s
quick-relief medicines. They should
understand when and how to use them
and when to seek medical care for
your child.

You shouldn’t use quick-relief
medicines in place of prescribed longterm
control medicines. Quick-relief
medicines don’t reduce inflammation.

Emergency Care
Most people
who have asthma, including many
children, can safely manage their
symptoms by following the steps for
worsening asthma provided in the
asthma action plan. However, you
may need medical attention. Call
your doctor for advice if

your medicines don’t relieve an
asthma attack.

your peak flow is less than half of
your personal best peak flow number.

Call 9-1-1 for an ambulance to
take you to the emergency room of
your local hospital if

you have trouble walking and talking
because you’re out of breath.

you have blue lips or fingernails.

At the hospital, you will be closely
watched and given oxygen and more
medicines, as well as medicines at
higher doses than you take at home.
Such treatment can save your life.

Are Allergies Making You Fuzzy?

Sneezing, wheezing, watery eyes,
and a runny nose aren’t the only
symptoms of allergic diseases.
Many people with allergic rhinitis also
report feeling “slower” and drowsy. When
their allergies are acting up, they have
trouble concentrating and remembering.

For instance, allergic rhinitis can be
associated with decreased ability to concentrate
and function, activity limitation,
decreased decision-making capacity, impaired
hand-eye coordination, problems
remembering things, irritability, sleep
disorders, fatigue, missed days at work
or school, more motor vehicle accidents,
and more school or work injuries.

Many parents of children with allergic
rhinitis observe increased bad moods
and irritability in their child’s behavior
during the allergy season. Since children
cannot always express their uncomfortable
or painful symptoms verbally, they
may express their discomfort by acting
up at school and at home. In addition,
some kids feel that having an allergic
disease is a stigma that separates them
from other kids.

It is important that the irritability
or other symptoms caused by ear, nose,
or throat trouble not be mistaken for
attention deficit disorder. With proper
treatment, symptoms can be kept under
control and disruptions in learning and
behavior can be avoided.

Causes
Experts believe the top two
culprits contributing to cognitive impairment
of people with allergic rhinitis are
sleep interruptions and sedating antihistamine
(over-the-counter) medications.

If you have bad allergic rhinitis, you may
waken a dozen times a night.

Secondary factors, such as blockage
of the Eustachian tube (ear canal),
also can cause hearing problems that
have a negative impact on learning
and comprehension. Constant nose
blowing and coughing can interrupt
concentration and the learning process,
and allergy-related absences
from school or work can cause people
to fall behind.

Sleep Disruption
Chronic nasal
congestion can cause difficulty in breathing,
especially at night. Waking is a
hard-wired reflex to make you start
breathing again. If you have bad allergic
rhinitis, you may waken a dozen
times a night. Falling back asleep can
be difficult, cutting your total number
of sleep hours short.

The average person needs about eight
hours of sleep per night to function normally
the next day. Losing just a few
hours of sleep can lead to a significant
decrease in your ability to function.
Prolonged loss of sleep can cause difficulty
in concentration and ability to
remember things, and can contribute to
automotive accidents. Night after night
of interrupted sleep can cause serious
decreases in learning ability and performance
in school or on the job.

Over-the-Counter Medications
Most allergy therapies don’t take into
account the effects of allergic rhinitis
on mental functioning – they treat the
more obvious physical symptoms. Some
allergy therapies may even cause some
cognitive or mental impairment. The
most commonly used over-the-counter
medications for allergy symptoms are
decongestants and first-generation antihistamines,
such as diphenhydramine
(Benadryl®), both of which can cause
sleep disturbances.

Decongestants constrict small blood
vessels in the nose. This opens the nasal
passageways and lets you breathe
easier. Some decongestants are available
over the counter, while higher
strength formulas are available with a
prescription. In some people, oral decongestants
can cause problems with
getting to sleep, appetite loss, and irritability,
which can contribute to allergy
problems. If you have any of these symptoms,
discuss them with your allergist.

Antihistamines block the effects of
histamine, a chemical produced by the
body in response to allergens. Histamine
is responsible for the symptoms
of allergic rhinitis. First-generation
over-the-counter antihistamines available
in the United States also can cause
drowsiness. Regularly taking over-thecounter
antihistamines can lead to a
feeling of constant sluggishness, affecting
learning, memory, and performance.
Newer second-generation antihistamines
are designed to minimize
drowsiness while still blocking the
effects of histamine.

Solutions
The best way to control
your symptoms is to avoid your triggers.
This is often easier said than done. If
your allergens can’t be avoided, your
allergist can help you create an allergy
treatment plan. Several types of nonsedating
medications are available to
help control allergies. If medications
are not effective or cause unwanted
side effects, your allergist may suggest
immunotherapy, or allergy shots. Immunotherapy
is used to treat allergy to
pollen, ragweed, dust mites, animal dander,
and other allergens. This process
gradually desensitizes you to these substances
by changing the way your body’s
immune system responds to them.

If allergies are affecting your ability
to concentrate or function, several treatment
options may be beneficial. Getting
allergy symptoms under control can
help you sleep at night and function
during the day.

If you suspect that you or a family
member may have an allergic disorder,
make an appointment with your allergist
for proper diagnosis. Treating allergies
sooner rather than later can help prevent
disruptions in learning and behavior.

Source: American College of Allergy, Asthma & Immunology, www.acaai.org

This article was originally published in Coping® with Allergies & Asthma magazine,
September/October
2011.

Living with Asthma

Asthma is a long-term disease
that requires long-term care.
Successful asthma treatment
requires you to take an active role in
your care. Taking an active role to
control your asthma involves working
with your doctor and other clinicians
on your healthcare team to create and
follow an asthma action plan. Children
aged 10 or older – and younger children
who are able – also should take an active
role in their asthma care.

Learn How to Manage Your
Asthma
Partner with your doctor to
develop an asthma action plan. This
plan will help you to properly take
your medicines, identify your asthma
triggers, and manage your disease if
asthma symptoms worsen.

If your child has asthma, all of the
people who care for him or her should
know about the child’s asthma action
plan. This includes babysitters and
workers at daycare centers, schools,
and camps. These caretakers can
help your child follow his or her
action plan.

Most people who have asthma can successfully
manage their symptoms at home by following their
asthma action plans and having regular checkups.

Most people who have asthma can
successfully manage their symptoms
at home by following their asthma action
plans and having regular checkups.
However, it’s important to know when
to seek emergency medical care.

Learn how to use your medicines
correctly. If you take inhaled medicines,
you should practice using your inhaler
at your doctor’s office. If you take longterm
control medicines, take them daily
as your doctor prescribes.

Record your asthma symptoms as
a way to track how well your asthma is
controlled. Also, you may use a peak
flow meter to measure and record how
well your lungs are working. Your
doctor may ask you to keep records
of your symptoms or peak flow results
daily for a couple of weeks before an
office visit and bring these records
with you to the visit.

These steps will help you keep track
over time of how well you’re controlling
your asthma. This will help you
spot problems early and prevent or relieve
asthma attacks. Recording your
symptoms and peak flow results to
share with your doctor also will help
him or her decide whether to adjust
your treatment.

Ongoing Care
Have regular asthma
checkups with your doctor so he or she
can assess your level of asthma control
and adjust your treatment if needed.
Remember, the main goal of asthma
treatment is to achieve the best control
of your asthma using the least amount
of medicine. This may require frequent
adjustments to your treatments.

If it’s hard to follow your plan or the
plan isn’t working well, let your healthcare
team know right away. They will
work with you to adjust your plan to
better suit your needs. You should also
get treatment for any other conditions
that can interfere with your asthma
management.

Watch for Signs That Your Asthma
is Getting Worse
Your asthma may be
getting worse if

your symptoms start to occur more
often, are more severe, and/or bother
you at night and cause you to lose sleep.

you’re limiting your normal activities
and missing school or work because of
your asthma.

your peak flow number is low compared
to your personal best or varies a
lot from day to day.

your asthma medicines don’t seem
to work well anymore.

you have to use your quick-relief
inhaler more often. If you’re using
quick-relief medicine more than
two days a week, your asthma isn’t
well controlled.

you have to go to the emergency room
or doctor because of an asthma attack.

If you have any of these signs, see
your doctor. He or she may need to
change your medicines or take other
steps to control your asthma.

Emergency Care
Most people who
have asthma, including many children,
can safely manage their symptoms by
following the steps for worsening asthma
provided in their asthma action plan.
However, you may need medical attention.
Call your doctor for advice if
your medicines don’t relieve an asthma
attack or your peak flow is less than half
of your personal best peak flow number.

Call 911 for an ambulance to take you
to the emergency room of your local
hospital if you have trouble walking and
talking because you’re out of breath or
you have blue lips or fingernails.

At the hospital, you will be closely
watched and given oxygen and more
medicines, as well as medicines at higher
doses than you take at home. Such
treatment can save your life.

Partner with your healthcare team
and take an active role in your care. This
can help control asthma so it doesn’t
interfere with your activities and disrupt
your life.

New Survey Reveals Emotional Impact of Food Allergy on Children

A recent survey conducted by
the Food Allergy & Anaphylaxis
Network and Galaxy Nutritional
Foods examined parents’ perspectives
on the emotional impact
that food allergies have on their
children.

Nearly 70 percent of the parents
of children with food allergies
surveyed said having a food allergy
has affected their child’s quality
of life, with 40 percent indicating
their child’s life was impacted
“somewhat,” and 29 percent “a
great deal.”

The survey also asked parents
about food allergy prevalence in
schools and societal understanding
of the medical condition. According
to the survey, 47 percent of
parents indicated that they were
aware of one to two other children
in their child’s classroom who also
had food allergies. This finding is
in line with the latest statistics that
show 1 in 13 U.S. children have
a food allergy. Additionally, the
survey found that a majority of
parents of children with a food
allergy felt that school personnel
had an “excellent” or “good” understanding
of food allergy.

The survey also explored participation
in everyday life events
– activities that most of the general
population takes for granted.
For parents of children with food
allergies, common events such as
eating out at a restaurant, attending
a birthday party, or sleeping
over at a friends’ house can be concerning.
According to the parents
surveyed, they choose not to have
their children participate in many
of these everyday life events.

This article was originally published in Coping® with Allergies & Asthma magazine,
September/October
2011.

Get Relief from Sinus Pain

Your nose is stuffy. You have
thick, yellowish mucus. You’re
coughing, and you feel tired
and achy. You think that you have a cold.
You take medicines to relieve your symptoms,
but they don’t help. When you
also get a terrible headache, you finally
drag yourself to the doctor. After listening
to your history of symptoms and
examining your face and forehead, the
doctor says you have sinusitis.

What Is Sinusitis? Sinusitis simply
means your sinuses are inflamed – red
and swollen – because of an infection
or another problem. There are several
types of sinusitis:

♦Acute, which lasts up to 4 weeks ♦Subacute, which lasts 4 to 12 weeks ♦Chronic, which lasts more than 12
weeks and can continue for months
or even years ♦Recurrent, with several attacks
within a year

What Causes Sinusitis?
Anything
that causes swelling in the nose can block
the openings between your paranasal
sinuses and your nose, including a cold,
allergies, or a reaction to some chemical
to which you’ve been exposed. The
blockage causes air and mucus to become
trapped within the sinuses. This
may cause pain and thickened mucus.

If you have nasal allergies along with sinusitis,
your doctor may recommend medicine to control
your allergies.

The pain of a sinus attack arises because
the trapped air and mucus put
pressure on the mucous membrane of
the sinuses and the bony wall behind it.
Also, when a swollen membrane at the
opening of a paranasal sinus prevents
air from entering into the sinuses, it can
create a vacuum that causes pain.

Mucus thickens because it loses its
water content as it stays trapped inside
the sinuses for a long time. In addition,
inflammation leads to extra materials
being secreted into the mucus, causing
thickening.

How Is Sinusitis Treated?
If you
have acute sinusitis, your doctor may
recommend antibiotics to control a bacterial
infection, if present; pain relievers
to reduce any pain; or decongestants.
Even if you have acute sinusitis, your
doctor may choose not to use an antibiotic
because many cases of acute
sinusitis will end on their own. However,
if you do not feel better after a few days,
you should contact your doctor again.

If you have nasal allergies along with
sinusitis, your doctor may recommend
medicine to control your allergies. This
may include a nasal steroid spray that
reduces the swelling around the sinus
passages and allows the sinuses to drain.

If you have asthma and then get sinusitis,
your asthma may worsen. You
should contact your doctor, who may
change your asthma treatment.

Healthcare professionals often find
it difficult to treat chronic rhinosinusitis
successfully. They have two options to
offer: medicine and surgery.

Nasal steroid sprays are helpful for
many people, but most people still do
not get full relief of symptoms with these
medicines. Physicians occasionally
recommend a long course of antibiotics,
but results from clinical research do not
support this kind of antibiotic use. Saline
washes or saline nasal sprays can
be helpful in chronic rhinosinusitis because
they remove thick secretions and
allow the sinuses to drain. Oral steroids,
such as prednisone, may be prescribed
for severe chronic rhinosinusitis. However,
oral steroids are powerful medicines
with significant side effects, and these
medicines typically are prescribed when
other medicines have failed.

When medicine fails, surgery may be
the only alternative for treating chronic
rhinosinusitis. The goal of surgery is
to improve sinus drainage and reduce
blockage of the nasal passages. Nasal
surgery usually is performed to enlarge
the natural openings of the sinuses, remove
nasal polyps, or correct significant
structural problems inside the nose and
the sinuses if they contribute to sinus
obstruction. Although most people have
fewer symptoms and a better quality of
life after surgery, problems can reoccur,
sometimes even after a short period.

In children, problems can sometimes
be eliminated by removing the adenoids.
These gland-like tissues, located high in
the throat behind and above the roof of
the mouth, can obstruct the nasal passages.

Can Sinusitis Be Prevented?
There
are no methods that have been scientifically
proven to prevent acute or chronic
sinusitis. However, some measures
may help.

Keep your nose as moist as possible
with frequent use of saline sprays or
washes. Avoid very dry indoor environments
and use a humidifier, if necessary.
Be aware, however, that a humid environment
also may increase the amount
of mold, dust mite, or cockroach allergens
in your home; this is important
only if you are allergic to any of these
organisms.

Avoid exposure to irritants, such
as cigarette and cigar smoke, or strong
odors from chemicals. Avoid exposure
to substances to which you are allergic.
If you haven’t been tested for allergies
and you are getting frequent sinus infections,
ask your doctor to give you
an allergy evaluation or refer you to
an allergy specialist.

Most States Don't Make the Grade on Asthma & Allergy School Health

For over 7 million children with asthma, and 13 million with food allergy or other severe allergies, going to school is a daily risk affecting how well they can – or can't – manage their diseases. Now for the fourth year, the Asthma and Allergy Foundation of America (AAFA) has released its annual report assessing all 50 states and the District of Columbia on their leadership and progress on school-based policies that address student asthma and allergy health in more than 100,000 elementary, middle and high schools across the U.S.

The result: most states still don't make the grade.

Signs of Leadership
Each year, the Foundation's report, the "State Honor Roll™ of Asthma and Allergy Policies for Schools," outlines 18 school-related core policies proven to affect positive healthy school environments, then assesses each state on how many of these policies they have adopted. If a state has enacted at least 15 of the policies, it is listed on the Foundation's "Honor Roll." This year, six states achieved this distinction:

Connecticut

Massachusetts

New Jersey

Rhode Island

Vermont

Washington

AAFA is announcing the results of the study at an international medical conference in Boston this weekend. Full results, including detailed state profiles and charts, are available at www.StateHonorRoll.org. The report Web site also has several links to free resources for parents, advocates, schools and policymakers.

Core policies include state-wide standards for appropriate school nurse-to-student ratios, laws allowing students to carry and administer their asthma and anaphylaxis medication, indoor air quality for school buildings, smoking bans, and more.

"New England has been committed to student health, and public health overall, for decades," says Judi McAuliffe, RN, a school nurse in the Pembroke, Massachusetts, school district. "I'm not really surprised that we continue to lead the rest of the country on asthma and allergy health, I just wish others would follow," says McAuliffe. According to the Foundation, these 6 Honor Roll states demonstrate leadership on asthma and allergy school health. "They provide a blueprint for parents and patient advocates around the country," says Tom Flanagan, Chair of AAFA's national Board of Directors, and a parent of a child with severe allergies," but there has been limited progress in too few places for such a huge public health problem."

The Burden on Schools
In the United States, asthma and allergies have a major and growing affect on schools. About 10 percent of kids (7.1 million children) have asthma. It is the #2 chronic disease among children (behind obesity) and the #1 chronic cause of student absenteeism (10.5 million school days missed annually due to asthma in 2008). Last year, 185 children died because of asthma. In addition, severe allergies and anaphylaxis – the most severe type of allergic reaction – are on the rise nationwide, particularly food allergies among children, forcing schools to prepare, manage and react to the problem. Plus, millions of adult teachers and staff in schools have asthma and allergies, as well.

With so many people affected in the school setting, these diseases create a burden on schools and communities, requiring improvements to indoor air quality (IAQ), emergency procedures and prevention training for food allergies, individual health plans for students, notifying parents of pesticide spraying, student access to medications such as epinephrine auto-injectors or albuterol inhalers, campus smoking bans and cessation programs, and more.

Many States Have Few Protections
While thousands of local schools and districts may show innovation and leadership in support of students and staff with asthma and allergies, strong state-wide policies are lacking throughout the U.S., with some rare bright spots. "Four New England states, New Jersey and Washington State have been on our Honor Roll for 4 years," says Charlotte Collins, JD, AAFA's Vice President of Policy and Programs, "but the gap from coast to coast is wide, with most states simply falling short. In fact, twelve states failed to achieve even half of the core policy standards," says Collins.

Even though broad improvements in the states has not yet been seen, AAFA found that overall, most states are at least taking a few steps each to address the needs of students with asthma and allergies in the school setting. For example, most states now protect student access to their own medications, document chronic diseases, and prohibit smoking at school and on school buses. Currently, about half of the states fail to require schools to develop emergency protocols for asthma and anaphylaxis emergencies, and only five recommend that schools provide at least one nurse per 750 students.

Anaphylaxis on the Policy Frontier
"One major positive finding in this year's report is that nearly every state in the U.S. now has a law allowing students to carry and self-administer their epinephrine auto-injectors for allergic emergencies," says Flanagan. This is a major development compared to just 10 years ago when few states allowed – and in fact prohibited – such access. Wisconsin and New York still don't have this law but their legislatures are considering policies, "so those states are behind on this right now while all the other states are leading the way," says Flanagan.

Now that student self-use of epinephrine has near nationwide acceptance, other access issues have emerged. Surprisingly, states do not regulate emergency services consistently. Depending on where you live, some emergency medical technicians (EMTs) may not have access to epinephrine, or may not be permitted to administer the medication, or only permitted to assist administering a patient's own epinephrine auto-injector device. "This is a definite area of concern since school personnel rely on 911 services in these types of emergencies," says Collins.

About the Study
For the State Honor Roll report, AAFA assessed three categories of policies: Medication & Treatment policies, Awareness policies and School Environment policies. Within these categories AAFA research and policy experts, in consultation with leaders in the fields of medicine, education and advocacy, identified 18 types of "core policy standards" relating to asthma and allergies in schools across the U.S. For example, core policies include state-wide standards for appropriate school nurse-to-student ratios, laws allowing students to carry and administer their asthma and anaphylaxis medications in school, indoor air quality improvement policies for school buildings, smoking bans and cessation programs, and more.

The full report, methodology, tables, detailed state profiles, as well as back-to-school tips and tools, are available at www.StateHonorRoll.org. The 2011 report is made possible in part by a grant from Dey Pharma L.P., and individual donations to AAFA from patients, families and supporters.

The Asthma and Allergy Foundation of America (AAFA) is a not-for-profit organization dedicated to improving the quality of life for people with asthma, allergies and related conditions through education, advocacy and research. For more asthma and allergy statistics or support, visit www.aafa.org or call 1-800-7-ASTHMA.

Obese Asthmatic Children Experience More Complications with Anesthesia

A study presented at ANESTHESIOLOGY 2011 found that obese asthmatic children were nearly two times as likely to have at least one respiratory complication during or after surgery compared to their lean peers.

“Respiratory problems are one of the major causes of complications and death during pediatric anesthesia,” said the study’s lead investigator, Olubukola O. Nafiu, MD “Obesity and asthma are commonly cited as risk factors for respiratory problems. This study was designed to examine whether complications were more frequent in obese children with asthma.”

"The association of obesity and asthma with an increase in respiratory complications suggests that obese asthmatic children undergoing anesthesia should receive additional evaluation and care to prevent the increased potential for complications."

The study prospectively examined 1,102 children, 107 (9.7%) obese asthmatics, 118 (10.7%) normal weight asthmatics, 309 (28.0%) obese patients and 568 (51.5%) normal weight non-asthmatics. There was no significant difference in age between or within the groups. Children in the obese-asthmatic and obese groups were more likely to have at least one respiratory complication during or after surgery compared to the other groups. Additionally, obese-asthmatic children were more likely to have a longer post anesthesia unit stay.

“The association of obesity and asthma with an increase in respiratory complications suggests that obese asthmatic children undergoing anesthesia should receive additional evaluation and care to prevent the increased potential for complications,” said Dr. Nafiu. “Future investigations into what is directly causing complications in these patients are needed.”

The Eyes Have It!

Allergic Conjunctivitis, That Is

Eye allergy, also called allergic
conjunctivitis or ocular allergy, occurs
when something you are allergic to irritates
the conjunctiva. This is the delicate
membrane covering the eye and the
inside of the eyelid.

The most common causes of allergic
conjunctivitis are seasonal allergens,
such as pollen and mold spores. People
with seasonal allergic rhinitis, or hay
fever, normally notice their symptoms
worsen when they go outdoors on days
with high pollen counts.
Indoor allergens, such as dust mites
and pet dander, can also cause eye allergies
year-round. If you have this type
of allergy, you may notice your symptoms
worsen during certain activities,
such as cleaning your house or grooming
a pet.

Eye allergy symptoms can be very
annoying. Yet they pose little threat to
eyesight other than temporary blurriness.
Unlike conditions such as pink
eye, allergic conjunctivitis is not contagious.
However, red, itchy, burning,
and puffy eyes can also be caused by
infections and other conditions that
can threaten eyesight.

Eye Allergy Symptoms & Diagnosis
If your symptoms are related to an eye
allergy, chances are you will have
problems in both eyes. Typical symptoms
include watery eyes, itchiness,
sensitivity to light, redness, grittiness,
and eyelid swelling. These symptoms
can occur alone or along with allergic
rhinitis nasal symptoms. They typically
appear shortly after exposure to the
allergen. Symptoms resulting from
seasonal outdoor allergens tend to be
worse than symptoms due to indoor
allergens. Symptoms may be reduced
if you are taking allergy medications
such as antihistamines, which suppress
the allergic reaction.

Unlike conditions such as pink eye, allergic conjunctivitis
is not contagious.

The first step toward relief from
annoying eye allergy symptoms is
a proper diagnosis. An allergist has
specialized training and experience to
accurately determine what is causing
your symptoms and identify the best
treatment approach.

Eye Allergy Treatment & Management
If indoor allergens are causing
your eye allergy symptoms, avoidance
is the key to relief. Use a vacuum with
a HEPA filter to reduce dust in your
home or try keeping pets out of the bedroom
to reduce exposure to their dander.

If pollen and other seasonal allergens
are causing your symptoms, medications
or other treatments may be necessary
to provide relief. Over-the-counter
antihistamine pills and eye drops are
often used for short-term treatment
of eye allergy symptoms. However,
prolonged use of some eye drops may
actually make your symptoms worse.
Your doctor may prescribe stronger
medications if your symptoms are
long lasting.

Corticosteroid eye drops are effective,
but they often have side effects,
even when used only for a short time.
Use of this medication should be managed
by an ophthalmologist due to the
risk of side effects, such as glaucoma,
cataracts, and infection.

Depending on what is causing your
eye allergy symptoms, immunotherapy
(allergy shots) can be very effective in
providing long-term resistance to the
triggering allergens.

Immune Cell Plays Dual Role in Allergic Skin Disease

NIH-funded study in mice enhances understanding of atopic dermatitis

An immune cell involved in initiating the symptoms of an allergic skin reaction may play an equally, or perhaps more important, role in suppressing the reaction once it becomes chronic. This finding in mice could have future implications for the treatment of atopic dermatitis, a chronic inflammatory skin disease that affects an estimated 10 to 20 percent of infants and young children. The research is by investigators at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health.

The study, published online in the journal Immunity, and led by Juan Rivera, PhD, NIAMS deputy scientific director and chief of the Laboratory of Molecular Immunogenetics, focused on a type of cell called a mast cell. Previous research has shown that early in the course of atopic dermatitis, mast cells produce irritating chemicals, including interleukin-4 (IL-4), interleukin-5 (IL-5) and interleukin-6 (IL-6), which attract inflammatory cells to the site of the allergic reaction.

To better understand mast cells' role, the researchers developed a mouse model. After initial exposure to a chemical allergen, mice are subsequently challenged by having their ears painted with the same allergen multiple times. This model is similar to atopic dermatitis in people. Some of the mice were also engineered to be deficient in mast cells.

"The new study is an important step toward providing researchers with a valuable new insight that could eventually lead to safer, more targeted treatments."

When the scientists painted a chemical allergen one time on the ears of the mast cell-deficient mice, the reaction occurred more slowly, demonstrating that mast cells contribute to the initiation of atopic dermatitis.

"When they applied the same allergen to these mice multiple times, the reaction was considerably worse than in mice with sufficient mast cells," said Rivera. "That tells us that although mast cells may participate early on in the development of the disease, it appears that they are suppressing the late stages of the disease or when the disease becomes chronic."

In fact, when the scientists replaced the mast cells in mast cell-deficient mice, they were able to reduce the severity of the disease. The researchers were surprised that the mast cells did not have to be at the site of inflammation to control inflammation, said Rivera. In fact, the greatest effect was seen with mast cell repopulation in the spleen, a key organ in immune response.

Further investigation showed that, in late stages of disease, the mast cells underwent a change that caused them to produce a different chemical called interleukin-2 (IL-2), needed by cells which are key to suppressing inflammation, known as regulatory T cells.

"What is unusual here is that the same type of cells that can be inflammatory, can also be regulatory," said Rivera.

While Rivera says it's too early to predict the therapeutic importance of these findings, he believes they do provide new information on the understanding of atopic dermatitis and a potential caution against the development of treatments that target mast cells.

"While blocking mast cells has been considered as a treatment for the disease, it may be counter-productive, particularly in the latter stages of the disease," he said.

The researchers' next step is to see if their findings hold true in people, comparing the products of mast cells from lesions in early– and late-stage atopic dermatitis. It's possible, for example, that individuals with very severe chronic disease may not have sufficient mast cells in the skin.

Currently, the most effective treatment for atopic dermatitis is topical corticosteroids, which can have significant side effects, including thinning of the skin, if used long-term.

"In general, we need a better understanding of the disease itself to develop better therapies for it," said Rivera. "The new study is an important step toward that end, providing researchers with a valuable new insight that could eventually lead to safer, more targeted treatments."

Who Gets Asthma and Why?

Asthma is very common, affecting
more than 22 million people in the United
States. No one knows for sure why some
people have asthma and others don’t.
People who have family members with
allergies or asthma are more likely to
have asthma.

Asthma can occur at any age but is
more common in children than in adults.
Heredity can play a role. In young children,
boys are nearly twice as likely as
girls to develop asthma, but this sex difference
tends to disappear in older age
groups. Obesity is a newly identified
risk factor for asthma.

Causes
People generally think of
asthma in terms of episodes or attacks.
Actually, the asthmatic condition is
always present, but symptoms may be
dormant until triggered by an allergen,
respiratory infection, or cold weather.
Other triggers may include aspirin,
environmental irritants, physical exertion,
and less commonly, food additives
and preservatives.

Allergens are substances that cause
no problem for a majority of people but
that trigger an allergic reaction in susceptible
individuals. Allergens are a major
source of breathing problems in both
children and adults. Common allergens
include plant pollen, dander from pets
and other animals, house dust mites,
cockroaches, molds, and certain foods.
When an allergic individual is exposed
to one of these allergens, a complicated
series of events causes the body to release
chemicals called mediators. These
mediators often trigger asthma episodes.

Allergens are a major source
of breathing problems in
both children and adults.

Cold air, smoke, industrial chemicals,
perfume, and paint and gasoline fumes
are all examples of environmental irritants
that can provoke asthma. They
probably trigger asthma symptoms by
stimulating irritant receptors in the respiratory
tract. These receptors, in turn,
cause the muscles surrounding the airway
to constrict, resulting in an asthma attack.

Viral respiratory infections are the
leading cause of acute asthma attacks.
Surprisingly, bacterial infections, with
the exception of sinusitis, do not bring
about asthma attacks. Some people
with heartburn can have asthma symptoms
when stomach acid backs up into
the esophagus.

Aspirin and aspirin-containing
products can trigger asthma attacks in
susceptible individuals. Five percent
of people with asthma experience a
significant decrease in lung function
after taking aspirin. Similar reactions
can occur with other over-the-counter
pain relievers, such as ibuprofen. As a
general rule, people with asthma should
avoid these products.

Another type of prescription medication
that can cause problems is the
group of drugs called beta-blockers,
which often are prescribed for high
blood pressure, glaucoma, migraine
headaches, and angina. Beta-blockers
can cause airway constriction called
bronchospasm, so it is important for
people with asthma to consult a physician
about the use of these medications.

Although food additives can trigger
asthma, this is rare. The most common
food trigger is sulfites, a preservative
used in products such as frozen potatoes
and some beers and wines.

The Difference Between Allergic
Disease and Asthma
Asthma is inflammation
and obstruction of airflow in the
bronchial tubes. Allergies are just one
of the factors that can trigger asthma
attacks. Not all people with asthma are
allergic, and there are many people who
have allergies but do not have asthma.

9 Common Allergy Triggers

An allergen is an otherwise
harmless substance that
the immune system
mistakes as being harmful. There are
many types of allergens and conditions
caused by them. Some people are allergic
to lots of things. Some people are allergic
to only one thing or to very few things.
What a person is allergic to is determined
by many different factors, including the
environment, a person’s genes, and the
way the immune system works.

Once an allergy has been identified,
your healthcare provider may recommend
medications or therapies to control
symptoms. The next step is to decrease
or eliminate exposure to the allergen.
This is called environmental control.
Evidence shows that allergy and asthma
symptoms may improve over time if
the recommended environmental control
changes are made.

Here are
the nine most common types of allergens.

Animals
Exposure to
animal dander (dead
skin that is continually
shed), as well as animal
urine and saliva,
causes human allergic
reactions to animals. These reactions
can make asthma, rhinitis, and eczema
symptoms worse in some people.

The dander, urine, and saliva of feathered
or furry animals, such as cats, dogs,
birds, and rodents, can cause allergy
symptoms. Exposure to other warmblooded
animals, such as horses or cattle,
or to products made with feathers or
down may also cause allergy symptoms.

Cockroaches
Cockroach
allergies are
remarkably common.
Cockroach allergies
may be dangerous to
people with asthma,
as exposure may cause severe attacks in
over half of those diagnosed. Even if
you’ve never seen a cockroach in your
home, the allergen may be present. It is
not necessarily a reflection of the cleanliness
of your home. Cockroaches live
in walls and other places you cannot
see or easily clean. Cockroaches can
congregate wherever food and warmth
are present. This can include restaurants,
hospitals, and bakeries, as well
as upscale urban dwellings.

Dust Mites
These are
microscopic animals,
too small to be seen
with the naked eye,
that feed on human
skin scales. They persist in bedding,
carpets, stuffed furniture, old clothing,
and stuffed toys. Dust mites are most
common in humid climates. If droppings
of dust mites are inhaled or come
in contact with the skin, they may cause
allergic symptoms and aggravate asthma
and eczema.

Stinging Insects
Although less common
than pollen allergy,
insect venom allergy
is anything but trivial
– it can be life threatening.
The primary offenders are most
often insects that sting rather than those
that bite. Stinging insects of concern
include yellow jackets, hornets, wasps,
bees, and ants.

Food
An allergic reaction
to a food is an
unpleasant reaction
caused by the immune
system overreacting
to a food. For those
who are allergic, it is important to diagnose
the allergy and identify the food so
that serious, and even life-threatening,
reactions can be avoided. The most
common food allergies are eggs, peanuts,
milk, tree nuts, fish, shellfish,
soy, and wheat.

Latex
A natural rubber
made from the
sap of a tree, latex
can be found in many
items, including bicycle
and wheelchair
tires, toys, some balloons, examining
gloves, household gloves, surgical tubing,
rubber bands, and condoms. The
major exposure of concern is to powdered
latex gloves, because latex sticks
to the powder and becomes airborne
when these gloves are put on, taken
off, or snapped.

When someone is allergic to latex, that
person is actually allergic to one or more
proteins found in the sap from the rubber
tree. Interestingly, these proteins – or
ones very similar – can be found in banana,
kiwi, avocado, potato, strawberries,
peaches, and chestnuts. Therefore, people
who are allergic to latex may have
cross-reactions to these foods.

Medication
Allergies
to medications are
complicated because
they can be caused by
many different medications,
resulting in a
wide variety of signs and symptoms
that may affect various organs or parts
of the body. However, one characteristic
of all drug allergies is that similar
symptoms will occur every time soon
after the offending medicine is taken.
Penicillin and other antibiotics are the
medicines that most commonly cause
allergic reactions.

Mold
Many types of
molds live in our environment.
Mold
grows in indoor and
outdoor areas that are
warm, dark, or moist.
Molds reproduce and grow by sending
tiny spores into the air. Inhaled spores
cause allergy and asthma symptoms.

Pollen
When pollen
from trees, grasses,
and weeds is inhaled,
it can cause allergy
and asthma symptoms.
Pollen may travel many
miles in the wind, so trees, grasses, and
weeds beyond your immediate area can
cause allergy and asthma symptoms.
Pollen allergies are often seasonal, and
allergy and asthma symptoms occur when
the amount of pollen in the air is high.

Brace Yourself: It’s Almost Flu Season

The flu is a contagious respiratory
illness caused by influenza
viruses. Most healthy people
recover from the flu without complications;
however, some people, such as
older people, young children, pregnant
woman, and people with certain health
conditions (like asthma), are at high risk
for serious complications from the flu.
If you are at high risk from complications
of the flu, you should consult your healthcare
provider to learn how to prevent the
flu. If you develop flu-like symptoms,
seek professional medical help.

Asthma & the Flu Shot
Every year,
the seasonal flu is responsible for causing
complications for people with asthma.
Getting a seasonal flu shot each year
is a very effective way to reduce your
chances of dealing with complications
due to flu symptoms.

If you have asthma, you should get
the flu shot when it is available. Do
not get the nasal spray vaccine, which
could trigger asthma symptoms or an
attack. If you have asthma and get
the flu, see a healthcare professional
promptly because you are at greater
risk of becoming severely ill with flu
complications very quickly. If you care
for children with asthma, get the flu
vaccine to protect them.

The single best way to prevent the flu is to
get a flu vaccine each fall.

The vaccine is safe. If you have
asthma, your health risks are far greater
in not getting the vaccine.

Allergies & the Flu Shot
If you have
a severe allergy to eggs, or to any other
substance that could be in the flu vaccine
(such as latex or gelatin), you should
check with your physician before receiving
any flu vaccine. If a person reports
a severe allergy to latex, vaccines supplied
in vials or syringes that contain
natural rubber should not be administered,
unless the benefit of vaccination
outweighs the risk of an allergic reaction
to the vaccine. For latex allergies other
than anaphylactic allergies, vaccines supplied
in vials or syringes that contain dry
natural rubber or natural rubber latex can
be administered. Allergic reactions (including
anaphylaxis) after vaccination
procedures are rare.

Common Flu Symptoms
The flu
usually starts suddenly and may include
symptoms such as fever, headache,
extreme tiredness, chills, constant cough,
sore throat, runny or stuffy nose, and
body aches. Diarrhea and vomiting
also can occur but are more common
in children.

These symptoms are referred to as
“flu-like symptoms.” Many different
illnesses, including the common cold,
allergy symptoms, and asthma symptoms,
can sometimes be similar and
confusing. Always consult with your
doctor to make a proper diagnosis.

If your runny nose, itchy and watery
eyes, sore throat, and other common
allergy symptoms are combined with
an unusually high fever (100 degrees
or higher), chills, severe headache, or
significant aches and pains, you could
have the flu. If you think your allergy
symptoms might be indicative of something
more severe, including the flu, you
should visit your doctor for a diagnosis
or treatment recommendation.

Spreading the Flu
The flu spreads
in respiratory spraying from coughing
and sneezing. It usually spreads from
person to person, though occasionally
someone could become infected by
touching something with virus on it and
touching his or her mouth or nose. Adults
may be able to infect others one day before
getting symptoms and up to seven
days after getting sick. So it’s possible
to give the flu before you know you’re
sick, as well as while you are sick.

Flu Prevention
The single best
way to prevent the flu is to get a flu
vaccine each fall. A few antiviral drugs
are approved for prevention of the flu.
These are prescription medications, and
a doctor should be consulted before
they are used.

In addition, here are some easy things
you can do to prevent the spread of respiratory
illnesses like the flu:

Cover your nose or mouth with a cloth
or tissue when you cough or sneeze –
throw it away after use.

Wash hands often with soap and water,
especially after coughing or sneezing. If
you don’t have access to running water,
use an alcohol-based hand cleanser.

Stay away from people who are sick.

If you get the flu, stay home from
work and school, and limit contact with
others to keep from infecting them.

Try not to touch your eyes, nose, or
mouth. This is how germs often spread.

Treating the Flu
Some antiviral
drugs are approved for treatment of the
flu. They are prescription medications,
and a doctor should be consulted before
the drugs are used. If you get the flu,
get plenty of rest, drink a lot of liquids,
and avoid using alcohol and tobacco.
You can take medications to relieve the
symptoms of the flu (but never give
aspirin to children or teenagers who have
flu-like symptoms, particularly fever).

Don’t Let Allergies & Asthma Haunt Halloween Fun

Halloween can be a frightful time
for parents of kids with allergies &
asthma. Nut-filled candy isn’t the only
bogeyman that can ruin the fun. Allergy
and asthma triggers can hide in other,
unexpected places, too, from dusty costumes
to leering jack-o’-lanterns.

“When people think of Halloweenassociated
allergies, they focus on candy
and often overlook many other potential
triggers,” says Myron Zitt, md, past president
of the American College of Allergy,
Asthma and Immunology. “By planning
ahead, you can ensure not only safe
treats, but also safe costumes, makeup,
accessories, and decorations.”

Watch out for these six sneaky triggers
to keep Halloween sneeze-, wheeze- and
reaction-free.

1 Tricky Treats
Food allergy triggers
abound on this candy-filled
holiday, and it’s not just the usual suspects
like chocolate that can hide triggers.
Gummy bears and other seemingly
innocent candies may contain gelatin,
a potential allergen that is a less common
trigger. Your best bet? Consider
taking your child to an allergist for allergy
testing and help in developing a
food allergy treatment plan. For Halloween
night, have some non-candy treats
for your child, such as stickers, pencils,
and small toys to swap for sweets.

2 Devilish Costume Details
Watch
out for nickel in costume accessories,
from cowboy belts and pirate
swords to tiaras and magic wands. Nickel
is one of the most common causes of
allergic contact dermatitis, which can
make skin itchy and spoil trick-ortreating
fun.

3 Haunted Hand-Me-Downs
Halloween
costumes packed away in
a box for months can be laden with
dust mites, which trigger allergies &
asthma. So unless you want your little
one sneezing or wheezing from house
to house, wash the hand-me-down costumes
in hot water. Or consider visiting
the store for a new costume.

4 Menacing Makeup
Cheap Halloween
makeup may include
preservatives that can cause allergic
reactions. Instead, opt for higher quality
theater makeup. Because it can take
a few days for a rash, swelling, or other
reaction to appear, test the makeup on
a small area of skin well in advance
of Halloween.

5 Frightful Fog
If you’re considering
renting a fog machine to make
your house extra spooky, think again.
Fog – real or man-made – can trigger
asthma in some people.

6 Perilous Pumpkins
Beware of
pumpkin-carving and pumpkin
pie if you think you might be allergic.
Pumpkin allergies, though rare, can
cause everything from itching to chest
tightness and can pop up quite suddenly,
even if you haven’t had a problem before.
And keep in mind that pumpkin
patches are often moldy and dusty, allergy
and asthma triggers for some.
Consider buying a pumpkin from a
grocery or discount store.

Source: American College of Allergy, Asthma & Immunology, www.acaai.org

This article was originally published in Coping® with Allergies & Asthma magazine,
September/October
2011.

Asthma in Infants and Very Young Children

Asthma is a disease in which
the airways become blocked or
narrowed. These effects are
usually temporary, but they cause shortness
of breath, breathing trouble, and
other symptoms. If an asthma attack is
severe, a person may need emergency
treatment to restore normal breathing.
Although asthma can cause severe health
problems, in most cases treatment can
control it and allow a person to live a
normal and active life.

How is asthma in very young children
different from adult asthma?
Infants and toddlers have much smaller
bronchial tubes than older children and
adults. In fact, these airways are so small
that even small blockages caused by
viral infections, tightened airways, or
mucus can make breathing extremely
difficult for the child.

Asthma symptoms can look like
symptoms of other illnesses or diseases.
Croup, bronchitis, epiglottis, cystic fibrosis,
pneumonia, bronchiectasis, upper
respiratory tract viruses, gastroesophageal
reflux, congenital abnormalities,
or even a foreign body inhaled by the
child all have some of the same symptoms
as asthma.

Diagnosing asthma in very young children is
difficult. Since they are not able to communicate,
they cannot describe how they are feeling.

Signs of asthma in a baby or toddler
include noisy breathing or breathing
increased 50 percent above normal;
wheezing or panting with normal activities;
lethargy or disinterest in normal or
favorite activities; difficulty sucking or
eating; and crying sounds softer, different.

How is asthma diagnosed in babies
and toddlers?
Diagnosing asthma in
very young children is difficult. Since
they are not able to communicate, they
cannot describe how they are feeling.
To help the pediatrician make a correct
diagnosis, parents must provide information
about family history of asthma or
allergies and the child’s overall behavior,
breathing patterns, and responses to
foods or possible allergy triggers. Lung
function tests are very hard to do with
young children. Instead, the physician
may see how the child responds to medications
to improve breathing. Blood
tests, allergy testing, and X-rays may be
done to gather additional information.
Using all this information, the doctor
then can make the best diagnosis.

How is asthma treated in very
young children?
Babies or toddlers
can use most medications used for
older children and adults. The dosage,
of course, is lower, and the way
the medication is given is different.
Inhaled medications are preferred
because they generally act more rapidly
to reduce symptoms and produce fewer
side effects.

Medications to treat asthma symptoms
in infants and toddlers are usually
given in a tasty liquid form or with a nebulizer.
A nebulizer is a small machine
that uses forced air to create a “medication
mist” for the baby to breathe through
a small facemask. Nebulizer treatments
take about 10 minutes and are given
several times each day until symptoms
decrease. Although a nebulizer treatment
is gentle, babies and young children
often are frightened by the mask and
fight the treatment at first.

Some toddlers are able to use an inhaler
containing asthma medication with
a spacer and mask attachment. A spacer
is a small tube that holds the medication
released by the inhaler fitted into it. The
device allows children to breathe in the
medication at their own speed.

Most people with asthma, including
very young children, use a combination
of medications, depending on severity
and frequency of symptoms. Work with
their healthcare providers to develop an
asthma care plan for your child.

Can a child outgrow asthma?
Once
someone develops sensitive airways,
they remain that way for life, although
asthma symptoms can vary through the
years. As a child’s airways mature, he
or she is able to handle airway inflammation
and irritants better, so asthma
symptoms may notably decrease. There
is no way to predict which children may
experience greatly reduced symptoms
as they get older. New triggers may
set off symptoms at any time in people
who have asthma. If your child has
asthma, keep quick-relief medications
on hand (and up-to-date), even if symptoms
are rare.

Tips for Parents
When a very young
child has a chronic illness, parents can
feel stretched to their limits as they try
to manage. Get regular check-ups to
help reduce your anxiety. Teach your
toddler or preschooler to tell you when
they are not feeling well.

It’s important to learn the warning
signs for increasing asthma in infants
and toddlers. Develop an asthma management
plan with your child’s physician.
Make sure the plan provides guidelines
to follow if asthma symptoms get worse.

Follow your asthma care plan every
day! Don’t alter from the plan until you
consult your healthcare provider. Even
if your child’s symptoms are gone, stick
with the plan until you discuss changes
with the doctor.

Above all, don’t let your child’s asthma
become the focus of your relationship.
If you use good healthcare practices to
manage your baby’s or toddler’s asthma,
you’ll be able to think less about asthma
and enjoy your child more.

Researchers at The Medical College of Wisconsin
investigating latex allergy in healthcare workers have demonstrated
that the most effective public health strategy to
prevent allergic sensitization is by stopping the use of powdered
latex gloves. Previous medical studies pointed out
this association of latex allergy to powdered latex glove use
but were not able to completely confirm this link in specific
workers. Reducing the use of powdered gloves reduced the
allergen in the air and in air ducts at two hospitals, and prevented
sensitization to latex in healthcare workers at both
institutions. These findings are published in the Journal of
Occupational and Environmental Medicine.

Kevin J. Kelly, MD, professor of Pediatrics (allergy/
immunology) and Internal Medicine and vice chair in Pediatrics
at the Medical College, and his colleagues studied
more than 800 healthcare workers at Froedtert Hospital and
Children’s Hospital of Wisconsin over a 4.5-year period.
Researchers tested the amount of latex allergen in the air ducts
of the employees’ primary work areas before and after both
institutions switched to powder-free gloves and found a significant
correlation between high levels of airborne allergen
and healthcare workers with a latex allergy or sensitivity.

The switch to powder-free gloves led to significant changes
at both hospitals. The unique study design allowed the investigators
to determine that there was a 16-fold reduction
in the rate of latex sensitization among the study participants.
Among the healthcare workers who were sensitized to latex
at the beginning of the study, 25 percent lost that sensitivity
and are no longer considered sensitized to latex. Whether
these fortunate workers will redevelop latex sensitization
if exposed to latex in the future is unknown.

The switch to powder-free gloves led to
significant changes at both hospitals.

“This study provides the strongest evidence that allergic
sensitivity to latex in healthcare workers is linked to airborne
allergen exposure through powdered gloves,” Dr. Kelly says.
“I believe these findings provide a roadmap for healthcare
institutions that will help minimize the risks of latex sensitization
to healthcare workers.”

Dr. Kelly’s team also found healthcare workers who had
demonstrated latex sensitization were nearly three times more
likely to leave their jobs. This phenomenon has been termed
“the healthy survivor” effect and helps explain why there
may be an artificial reduction in latex allergy seen in some
studies, as the affected workers choose to no longer be employed
without receiving workers’ compensation from a
work-related exposure.

This article was originally published in Coping® with Allergies & Asthma magazine,
September/October
2011.

Halloween Scares for Children with Allergies & Asthma

Parents of children with food allergies
are aware of the dangers lurking
in Halloween treats, but little attention
is paid to asthma, which can also be
frightening for asthmatic children participating
in Halloween festivities.

“If your child suffers from asthma
and/or allergies, be aware and prepared
for potential triggers to ensure a safe and
fun time for all during the holidays,”
says Clifford W. Bassett, MD, FAAAAI,
chair of the Public Education Committee
of the American Academy of
Allergy, Asthma & Immunology.

The Academy offers these tips to help
children with allergies & asthma safely
enjoy the holiday and stay out of hospital
emergency rooms:

Beware of Costumes
Mold, dust,
and latex products can be major allergy
and asthma triggers. Don’t recycle costumes
from the attic or basement,
and wash new costumes before wearing.
Halloween masks can trap dust
and mold, so keep your child mask free.

Don’t Enter Homes Keep your child
on the doorstep of homes while trick-or-treating.
Asthma and allergy triggers in
the houses of others may include cigarette
smoke and pet dander.

Watch for Weather Changes Cold
air and humidity can make breathing
difficult for children with asthma. Make
certain your child is dressed appropriately
for the conditions.

Under the Weather If your child
is not feeling well, hold off on trick-or-treating.
Cold and flu symptoms can
severely aggravate asthma conditions.

Lurking Food Allergies Halloween
can be troublesome for those with food
allergies. If this includes your child,
read every food label and be a “label
detective” so that you know what the
ingredients are before your child touches
or eats the product. This also means
avoiding homemade treats.

Be Prepared When trick-or-treating,
be prepared for an emergency. For food
allergies, carry an epinephrine pen. For
asthma, keep a rescue inhaler nearby.

Back to School with Asthma

Seven Steps to Stay Healthy During the School Day

The start of a new school year is
a big transition after the long
summer break, especially for
families of children with asthma. This
back-to-school season, the American
Lung Association stresses the importance
of preparing and carefully monitoring
a detailed action plan to manage asthma
and ease the transition to the school
environment.

“While new clothes and backpacks
are often thought of as back-to-school
necessities, it is even more essential for
parents of students with asthma to work
with their healthcare providers and the
school to develop a comprehensive action
plan detailing the various elements
of good asthma control in the school
environment,” says Dr. Norman H.
Edelman, chief medical officer of the
American Lung Association.

As the most common chronic childhood
disorder in the nation, asthma
affects an estimated seven million children
younger than 18. It is one of the
main illness-related reasons that students
miss school, accounting for more than
14 million lost school days every year.

Parents should also be aware that cold
and flu season is beginning as well. Influenza
poses a special health risk to
children with asthma, as these children
often experience more severe symptoms.
All children – especially those with
asthma – should be immunized against
influenza. Yet surveillance shows that
less than half of children with asthma are
vaccinated annually against influenza.

“As part of your back-to-school
preparation, make sure your child with
asthma gets a flu shot,” says Dr. Edelman.
“Flu epidemics start and spread
in schools, and the flu can lead to a
serious asthma attack.

“The good news is that research has
shown conclusively that getting a flu
shot does not trigger an asthma attack,
so there is no good reason not to get
one,” he adds. According to the U.S.
Centers for Disease Control, yearly flu
vaccinations should begin in September,
or as soon as the vaccine is available.

Even if your child’s asthma is well managed, asthma
action plans should be updated each school year.

In preparation for the school year
ahead, the American Lung Association
urges parents who have children with
asthma to complete the following
checklist:

♦ Develop an Asthma Action Plan
All students with asthma should have a
written asthma action plan that details
personal information about the child’s
asthma symptoms, medications, and any
medicine required before exercise, and
that provides specific instructions about
what to do if an asthma episode does not
improve with prescribed medication.

♦ Schedule an Asthma Check-up
Even if your child’s asthma is well
managed, asthma action plans should
be updated each school year, so schedule
a check-up with your healthcare
provider. This is critical to ensuring
your child’s asthma continues to be
effectively controlled, and provides
an opportunity to evaluate medications
and physical activity considerations.
Remember to give a copy of the completed
asthma action plan to your
child’s school.

♦ Vaccinate Yourself and Your Child
Against Seasonal Influenza The CDC
now recommends everyone over the age
of six months get a flu vaccination. Protecting
yourself against influenza by
getting vaccinated further helps protect
your child.

♦ Visit Your Child’s School Nurse and
Teachers All of your child’s teachers,
coaches, out-of-school activity organizers,
as well as the school nurse and office
should have a current copy of your child’s
asthma action plan. Discuss your child’s
specific triggers and typical symptoms
so that they can be prepared to effectively
assist your child should an asthma
episode occur outside of your presence.

♦ Know Your School’s Asthma Emergency
Plan Ensure that your child’s
school knows how to contact you in case
of an emergency. It is also important
for parents to know the school’s history
of dealing with asthma episodes. Parents
should confirm that school staff –
including after-school coaches and bus
drivers – have attended training to learn
how to respond to asthma emergencies.

♦ Advocate for Your Child In all 50
states, students have the legal right to
carry asthma medications while at school.
Check with your school nurse or administrator
for your school’s individual
policy, and meet with your child’s healthcare
provider to complete the required
paperwork.

♦ Know About Prescription Assistance
Services Don’t let the cost of
medicines be the reason that your child
doesn’t get the necessary treatment to
control his or her asthma. Talk to your
local healthcare provider about low-cost
or no-cost options that may be available
to you. Three organizations are available
to help. The Partnership for Prescription
Assistance can be reached by calling
(888) 4PPA-NOW. Rx Outreach also
provides information on their website,
rxoutreach.com. Patient Services Incorporated,
www.patientservicesinc.org, also
has helpful information available online.
Most pharmaceutical companies
offer prescription assistance programs
as well.

New App to Help People Dining Out with Food Allergies and Intolerances

People with food allergies and intolerances
struggle to find restaurants
that will accommodate their dietary
requirements. Now, there’s an app for
that. AllergyEats (allergyeats.com)
has launched a free app for the iPhone
and Android smartphones that provides
peer-based feedback about how well
(or poorly) restaurants accommodate
the needs of food allergic customers.
The AllergyEats app can be downloaded
from the iTunes app store and the Android
market.

This article was originally published in Coping® with Allergies & Asthma magazine,
September/October
2011.

Making Your House a Healthy Home

If you’re like most Americans,
you spend much of your
time indoors. Have you ever
stopped to think about whether the air
you’re breathing at home is healthy?
Research has found that in some
homes across America, the quality of
indoor air can be worse than outdoor
air. In part, this is because many homes
are being built and remodeled tighter.
You don’t have to be a building scientist
to deal with the quality of air in your
home; however, you should understand
a few basics to get you started.

Biological Pollutants (like molds
and dust mites)
Molds, mildew, fungi,
bacteria, and dust mites are some of the
main biological pollutants inside the
home. Some, such as pollen, are generated
outside the home. Mold and mildew
are generated in the home and release
spores into the air. Mold, mildew, fungi,
and bacteria are often found in areas
of the home that have high humidity
levels, such as bathrooms, kitchens,
laundry rooms or basements. Dust
mites and animal dander are problematic
when they become airborne during
vacuuming, making beds, or when
textiles are disturbed.

Allergic reactions are the most common health problems
associated with biological pollutants.

Molds and dust mites thrive in areas
of high humidity. Mold grows on organic
materials, such as paper, textiles,
grease, dirt, and soap scum. Mold spores
float throughout the house, forming new
colonies where they land. Dust mites
thrive on dead human skin cells and are
found in textiles, such as bedding, carpeting,
and upholstery. When these textiles
are disturbed during vacuuming, making
beds, or walking on carpet, the dust particles
become airborne. Pollen, plant
material that enters through windows or
on pets, and animal dander also become
airborne when disturbed. Infectious diseases
caused by bacteria and viruses are
generally passed from person to person
through physical contact, but some circulate
through indoor ventilation systems.

Health Effects
Allergic reactions
are the most common health problems
associated with biological pollutants.
Symptoms often include watery eyes,
runny nose and sneezing, nasal congestion,
itching, coughing, wheezing and
difficulty breathing, headache, dizziness,
and fatigue. Dust mites have been identified
as the single most important trigger
for asthma attacks.

Addressing the Problem
There
are no practical tests for biological contaminants
for use by nonprofessionals.
However, there are signs to watch for.
You can sometimes see and smell mold
colonies growing on surfaces. Mold
growth should be suspected wherever
there are water stains, standing water,
or moist surfaces.

Prevent mold growth by keeping
basements, bathrooms, and other rooms
clean and dry. Use a disinfectant to clean
surfaces that have mold on them. If carpeting
or furnishings become wet, they
must be quickly and thoroughly dried
or discarded.

Humidifiers, dehumidifiers, and air
conditioning condensing units should
be regularly cleaned with a disinfectant,
such as chlorine bleach. Keep humidity
at acceptable levels (less than 50 percent),
and make sure there’s plenty of
ventilation, especially in areas where
moisture tends to build up.

People who are sensitive to dust mites
may need to replace carpeting in their
homes with hard surfaced flooring and
use area rugs that can be removed and
cleaned. Vacuums with high efficiency
filters or central vacuum systems can
help reduce the airborne dust generated
by vacuuming.

Cleaning Up Mold
According
to the U.S. Environmental Protection
Agency, if the moldy area is less than
about 10 square feet, in most cases,
you can handle the job yourself, following
the guidelines below. If you
have health concerns, consult a health
professional before starting cleanup.

If you choose to hire a contractor to
do the cleanup, make sure the contractor
has experience cleaning up mold. For
do-it-yourself cleanup, note that the
use of a disinfecting chemical or biocide
that kills organisms such as mold
(chlorine bleach, for example) is not
recommended as a routine practice during
mold remediation, although there
may be instances where professional
judgment may indicate its use (for example,
when immune-compromised
individuals are present). In most cases,
it is not possible or desirable to sterilize
an area; background levels of mold
spores will remain, and these spores will
grow if the moisture problem has not
been resolved. If you choose to use
disinfectants or biocides, always ventilate
the area. Outdoor air may need
to be brought in with fans. Never mix
chlorine bleach solution with other cleaning
solutions or detergents that contain
ammonia because toxic fumes could
be produced.

In instances when a biocide is not
used, simply damp-wipe surfaces with
plain water or with water and detergent
solution (for wood, use wood floor
cleaner); scrub as needed. Always dry
completely after cleanup is completed.

In order to limit your exposure to airborne
mold during cleanup, you should
wear an N-95 respirator, available at
many hardware stores. In order to be
effective, the respirator or mask must fit
properly, so carefully follow the instructions
supplied with the respirator.

Symptoms of Allergic Rhinitis Result in Sleep Disturbances and Emotional Burdens

Results from Teva Respiratory’s
“Nasal Allergy Survey Assessing Limitations
2010” show that people with
allergic rhinitis who had nasal symptoms
were more likely to experience sleep
disturbances, including difficulty getting
to sleep and waking up during the night.
Lack of a good night’s sleep can significantly
affect a person’s quality of life.

Survey results suggest that the fatigue
people with nasal allergies experience
may be related to sleep disruption caused
by the common symptoms associated
with allergic rhinitis. Lack of adequate
sleep and increased tiredness may also
lead to people feeling “irritable” and
“miserable,” which can contribute to
other emotional burdens, like anxiety
and depression. When nasal symptoms
are at their worst, people find it difficult
to get a good night’s sleep, which can
negatively affect their work performance
by reducing productivity, resulting in
both social and economic costs.

“The negative impact that allergic
rhinitis symptoms can have on a patient’s
quality of sleep is considerable, as it not
only affects them physically, but also emotionally,”
says Gary Gross, MD, FAAAAI,
of Dallas Allergy & Asthma Center in
Dallas, TX. “It’s important for patients
suffering from allergic rhinitis symptoms,
like post-nasal drip, to understand how
these symptoms can negatively affect
their quality of life.”

This article was originally published in Coping® with Allergies & Asthma magazine,
Spring/Summer
2011.

Vitamin D Deficiency Linked with Airway Changes in Children with Severe Asthma

Children with severe therapy-resistant asthma (STRA) may have poorer lung function and worse symptoms compared to children with moderate asthma due to lower levels of vitamin D in their blood, according to researchers in London. Lower levels of vitamin D may cause structural changes in the airway muscles of children with STRA, making breathing more difficult. The study provides important new evidence for possible treatments for the condition.

The findings were published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

“This study clearly demonstrates that low levels of vitamin D are associated with poorer lung function, increased use of medication, worse symptoms and an increase in the mass of airway smooth muscle in children with STRA,” said Atul Gupta, MRCPCH, M.D., a researcher from Royal Brompton Hospital and the National Heart and Lung Institute (NHLI) at Imperial College and King’s College London. “It is therefore plausible that the link between airway smooth muscle mass and lung function in severe asthma may be partly explained by low levels of vitamin D.”

This is the first study to evaluate the relationship between vitamin D and the pathophysiology of children with severe therapy-resistant asthma.

While most children with asthma can be successfully treated with low doses of corticosteroids, about 5 to 10 percent of asthmatic children do not respond to standard treatment. These children have severe therapy-resistant asthma, or STRA, experience more asthma episodes and asthma-related illnesses, and require more healthcare services, than their treatment-receptive peers.

Although previous studies of children with asthma have linked increases in airway smooth muscle mass with poorer lung function and in vitro studies have established a connection between levels of vitamin D and the proliferation of airway smooth muscle, this is the first study to evaluate the relationship between vitamin D and the pathophysiology of children with STRA.

“Little is known about vitamin D status and its effect on asthma pathophysiology in these patients,” Dr. Gupta noted. “For our study, we hypothesized that children with STRA would have lower levels of vitamin D than moderate asthmatics, and that lower levels of vitamin D would be associated with worse lung function and changes in the airway muscle tissue.”

The researchers enrolled 86 children in the study, including 36 children with STRA, 26 with moderate asthma and 24 non-asthmatic controls, and measured the relationships between vitamin D levels and lung function, medication usage and symptom exacerbations. The researchers also examined tissue samples from the airways of the STRA group to evaluate structural changes in the airway’s smooth muscle.

At the conclusion of the study the researchers found children with STRA had significantly lower levels of vitamin D, as well as greater numbers of exacerbations, increased use of asthma medications and poorer lung function compared to children with moderate asthma and non-asthmatic children. Airway muscle tissue mass was also increased in the STRA group.

“The results of this study suggest that lower levels of vitamin D in children with STRA contribute to an increase in airway smooth muscle mass, which could make breathing more difficult and cause a worsening of asthma symptoms,” Dr. Gupta said.

The findings suggest new treatment strategies for children suffering from difficult-to-treat asthma, he added.

“Our results suggest that detecting vitamin D deficiency in children with STRA, and then treating that deficiency, may help prevent or reduce the structural changes that occur in the airway smooth muscle, which in turn may help reduce asthma-related symptoms and improve overall lung function,” Dr. Gupta said.

Before any widespread treatment recommendations can be made, however, larger studies will need to be conducted.

“The determination of the exact mechanism between low vitamin D and airway changes that occur in STRA will require intervention studies,” Dr. Gupta said. “Hopefully, the results of this and future studies will help determine a new course of therapy that will be effective in treating these children.”